tbuckley/cabot-search huggingface dataset:
PATH-20. CLINICAL FINDINGS AND PROGNOSIS OF ADULT GLIOBLASTOMA HARBORING A<i>BRAF V600E</i> MUTATION
Authors: Shigeru Yamaguchi, Yukitomo Ishi, Sogo Oki, Hiroaki Motegi, Kentaro Nishioka, Takashi Mori, Hiromi Okada, Zen-ichi Tanei, Shinya Tanaka, Miki Fujimura
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND AND AIM Although the BRAF V600E mutation is commonly associated with pediatric low-grade gliomas, glioblastomas (GB) with this mutation (BRAF-GB) have also been reported. The recent emergence of RAF and MEK inhibitors for BRAF V600E-positive tumors highlights the potential for targeted therapy in a subset of GB patients. This study aimed to characterize the clinical features and prognosis of BRAF-mutant glioblastomas. MATERIALS AND METHODS A retrospective analysis was conducted on a cohort of patients diagnosed with GB (confirmed by 2021 WHO criteria) above 16 years of age. Targeted genetic analysis for mutations in BRAF V600E, TERT promoter, and CDKN2A/B was performed on the GB samples. Clinical features of BRAF-GB were analyzed, and patients were further categorized into three groups: BRAF-GB, typical GB, and molecular GB. Subsequent analysis compared the prognosis among these groups. RESULTS Our study identified 11 cases (5.1%) harboring the BRAF V600E mutation among 215 adult GB patients. Patients with BRAF-GB exhibited a significantly younger median age of onset (38-year-old) compared to the typical GB (N = 167, 64-year-old) and molecular GB (N = 37, 61-year-old) groups. Further analysis of the BRAF-GB cohort (n=11) revealed a high prevalence (82%) of homozygous CDKN2A/B deletions, and only one case (9%) harbored a TERT promoter mutation. Interestingly, three BRAF-GB patients presented with hemorrhagic onset. Four cases showed evidence of prior lesions, with one case diagnosed histologically as a low-grade glioma 14 years earlier. The BRAF-GB group exhibited significantly longer median progression-free survival (32.8 months) and overall survival (84.2 months) compared to both the typical GB group (9.6 months and 18.9 months, respectively) and the molecular GB group (14.1 months and 32.1 months, respectively). CONCLUSIONS Early-age onset, with hemorrhagic onset or presence of prior lesions are factors that could lead to recommendation of BRAF analysis for adult GB patients.
CNSC-20. MONOSYNAPTIC TRACING DEFINES BRAIN-WIDE CIRCUIT CONNECTIVITY OF HUMAN GLIOBLASTOMA
Authors: Yusha Sun, Xin Wang, Daniel Zhang, Zhijian Zhang, Janardhan Bhattarai, Yingqi Wang, Kristen Park, Weifan Dong, Qian Yang, Feng Zhang, Keerthi Rajamani, Shang Mu, Benjamin Kennedy, Yan Hong, Jamie Galanaugh, Abhijeet Sambangi, Sang Hoon Kim, Garrett Wheeler, Tiago Goncalves, Qing Wang, Daniel Geschwind, Riki Kawaguchi, Angela Viaene, Ingo Helbig, Sudha Kessler, Ahmet Hoke, Huadong Wang, Fuqiang Xu, Zev Binder, Isaac Chen, Emily Ling-Lin Pai, Sara Stone, MacLean Nasrallah, Kimberly Christian, Marc Fuccillo, Nicolas Toni, Zhuhao Wu, Donald O’Rourke, Minghong Ma, Guo-li Ming, Hongjun Song
Journal: Neuro-Oncology (2024)

Abstract Glioblastoma (GBM), a deadly brain cancer, infiltrates the brain and can be synaptically innervated by neurons. Synaptic inputs onto GBM cells identified so far are largely short-range and glutamatergic in nature. The extent of integration of GBM cells into the brain-wide neuronal circuitry is therefore not well understood. We report the application of transsynaptic viral tracing approaches to study the neuronal connectome of GBM. We applied rabies virus-mediated retrograde tracing and herpes simplex virus (HSV)-mediated anterograde tracing approaches to characterize presynaptic partners in vivo in the adult mouse brain and ex vivo with iPSC-derived neurons, cortical organoid-GBM assembloids, and human surgical specimens. After transplantation into adult mice, GBM cells derived from multiple patients rapidly integrated into brain-wide neuronal circuits. GBM exhibited increased connectivity rates compared to transplanted neural progenitor cells, highlighting functional connectivity as a hallmark of malignant cells. Beyond glutamatergic inputs, we identified neuromodulatory inputs across the brain, including cholinergic inputs from the basal forebrain. We validated these long-range cholinergic neuron-to-glioma synapses signaling through the metabotropic CHRM3 receptor by high-resolution microscopy, anterograde monosynaptic HSV tracing, calcium imaging, and patch-clamp electrophysiology. To interrogate the functional effects of acetylcholine (ACh) on GBM, we performed calcium imaging and RNA sequencing analyses, which showed that ACh stimulation induced sustained calcium oscillations and long-lasting transcriptional reprogramming of GBM cells into a more invasive state via CHRM3. Importantly, CHRM3 activation promoted GBM cell invasion, whereas CHRM3 downregulation suppressed GBM cell invasion in vitro and in vivo, suggesting CHRM3 as a potential therapeutic target for this disease. Together, these results reveal the capacity of human GBM cells to robustly integrate into anatomically and molecularly diverse neuronal circuitry in the adult brain. They also support a model wherein rapid synapse formation onto GBM cells may promote a long-lasting increase in tumor cell fitness.
CNSC-51. PRIMARY INTRACRANIAL ALVEOLAR SOFT PART SARCOMA (PIASPS): A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES FROM 2000 – 2023
Authors: Haseeb Mehmood Qadri, Asif Bashir
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND AND OBJECTIVE Alveolar soft part sarcoma is a rare malignancy of the lower extremities considered to be of unknown cellular origin. Common in young female patients, the ASPS usually has a strong metastatic potential, mostly involving the lungs at the time of presentation. Cases involving the CNS primarily, without any evidence of systemic disease have emerged i.e. the primary intracranial alveolar soft part sarcoma (PIASPS). We aim to determine the clinical manifestations, natural progression and management of primary intracranial alveolar soft part sarcoma. MATERIALS AND METHODS After an extensive literature search using PubMed Central and Google Scholar, seven case reports and two case series of 14 patients with PIASPS were retrieved and included using the Preferred Reporting Items for Systemic review and Meta-analyses guidelines, published between 2000 and 2023. RESULTS Female preponderance of the neoplasm (57.14%) with an average age of 24.9 years was noted. Headache (36.36%) and papilledema (25%) were the most common presenting complaint and sign, respectively. Brain parenchymal involvement was noted in 71.42% cases, mostly the frontal lobe and left hemisphere. The lesion appeared isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images (66.67%) on MRI. Gross Total Resection was possible in 57.14% lesions. On immunohistochemistry, the tumor cells manifested TFE3 and PAS positivity in 25% and 20% of the cases respectively. An average survival after follow up duration was found to be 31.79 months. CONCLUSION Surgery and radiotherapy are the mainstay of treatment of PIASPS, while meningioma an important differential diagnosis. TFE3 fusion product is readily been helpful in diagnosis. Evidence of a primary lesion in the CNS cannot rule out the presence of an occult primary elsewhere in the body. This, along with the slow growing nature of the neoplasm and delayed localized recurrences, require a long-term follow-up.
CNSC-13. CROSSTALK BETWEEN SENSORY NEURONAL ACTIVITY AND TUMOR CELLS PROMOTES MALIGNANCY AND CANCER PAIN
Authors: Khalil Ali Ahmad Kasm, Kechen Ban, Khushboo Irshad, Ibdanelo Cortez, Cheng-En Shen, Anand Singh, Sami Mohd Rasheed, Kendal Willcox, Peter M Grace, Angela Hirbe, Andrew J Shepherd, Yuan Pan
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Nerve infiltration of solid tumors is associated with poor prognosis in multiple cancer types. Understanding the role of neuronal activity in cancer progression offers innovative approaches for treating malignancies and cancer-associated neurological issues such as pain. Pain perception is mediated by the activity of peripheral sensory neurons. Many cancer types induce pain, and sensory innervation could support tumor growth, raising the interesting hypothesis that cancer pain-associated neuronal activity promotes malignancies. Our study aims to test the hypothesis using malignant peripheral nerve sheath tumor (MPNST) as the experimental platform. METHODS in vivo allograft models were established by implanting mouse MPNST cells into the sciatic nerves of male and female mice, followed by performing pain behavior assays (von Frey, Hargreaves, and conditioned place preference tests) and tumor growth measurements. Primary mouse dorsal root ganglion (DRG) sensory neuron cultures were prepared for calcium imaging and neuron-tumor co-culture experiments. RESULTS MPNST tumor-bearing mice exhibited hypersensitivity to noxious and non-noxious stimuli (evoked pain) and ongoing pain, compared to the sham controls. MPNST-conditioned media increased intracellular calcium concentration and ATF3 (indicator for nerve injury/stress) expression in primary sensory neuron culture, suggesting that MPNST tumor cell secretory factors may induce pain by triggering sensory neuron injury/stress responses that increase sensory neuron activity/sensitivity. Reciprocally, we found that stimulation of sensory neuron activity accelerates MPNST tumor growth. The conditioned media from stimulated sensory neurons increased tumor proliferation (EdU assay) in vitro, suggesting that sensory neuron activity-induced paracrine factors increase MPNST cell growth. CONCLUSIONS MPNST is a devastating cancer that grows within peripheral nerves which induce intractable pain. Our findings demonstrate a feedforward cycle where the cancer cells induce sensory neuron hypersensitivity/hyperactivity (pain) which in turn further accelerates tumor growth. Future studies will identify the molecular mechanisms underlying this crosstalk between MPNST and sensory neuron activity.
IMMU-19. PRECLINICAL THERAPEUTIC ACTIVITY AND PET IMAGING OF STING AGONIST 8803 IN GLIOBLASTOMA
Authors: Hinda Najem, Spencer T Lea, Shashwat Tripathi, Lisa Hurley, Chao-Hsien Chen, Moloud Sooreshjani, Michelle L Bowie, Genevieve Hartley, Sebastian Pacheco, Crismita Dmello, Catalina Lee-Chang, Daniel Procissi, Rimas V Lukas, Maciej S Lesniak, David M Ashley, Michael A Curran, Irina Balyasnikova, Amy B Heimberger
Journal: Neuro-Oncology (2024)

Abstract STING (stimulator of interferon genes) activation triggers interferon (IFN) release within the tumor microenvironment from myeloid cells and other cell types, inducing proinflammatory anti-tumor immune responses. The small molecule STING agonist, 8803, elicits long-term survival in 56% (QPP4; p=0.0003) to 100% (QPP8; p&amp;lt;0.0001) of mice with orthotopically implanted immune checkpoint-resistant glioblastoma models after 2-3 doses. In humanized mice, in which glioblastoma-cell STING is epigenetically silenced, 8803 therapeutic activity is maintained. The combination therapy of 8803 with anti-PD-1 relatively further enhances survival in immune checkpoint-resistant models. Ex vivo flow cytometry and proteomic sequential multiplex profiling during the therapeutic window demonstrate global immunological reprogramming, specific tumor-antigen immune responses, increased tumor immune effector trafficking, and release of IFN. It has been shown that IFN signaling augments intracellular nucleotide metabolism and increases [18F]-FLT uptake in pancreatic cancer. We evaluated the longitudinal [18F]-FLT uptake in CT-2A-bearing mice using MRI/PET/CT at days 0, 2, and 4 after intratumoral 8803 delivery. Brain images were acquired before and after [18F]-FLT tracer and 8803 administrations. The CT was used for PET attenuation/correction, and the MRI was used for tumor segmentation. Regional analysis of PET-derived [18F]-FLT SUV maps used advanced image processing approaches as a function of time to enhance the voxel-by-voxel interpretation of the acquired images. [18F]-FLT uptake increased from baseline in all mice treated with 8803 compared to control mice with a peak at 48-96 hours. Concordant sequential multiplex immunofluorescence demonstrated that the STING expression was prominent along the tumor vasculature, myeloid, and tumor cells. p-IRF-3 expression, reflective of STING pathway activation, showed a diffuse pattern after treatment. Based on the preclinical data, PET imaging at 48-96 hours post-treatment represents the appropriate imaging modality and timepoint to maximize the ability to detect STING-dependent changes for a therapeutic strategy that reprograms the glioblastoma microenvironment and improves survival across multiple preclinical models of glioblastoma.
CTIM-31. PRELIMINARY RESULTS OF A PHASE II STUDY OF STEREOTACTIC RADIOSURGERY IN CONJUNCTION WITH THE PD-1 INHIBITOR PEMBROLIZUMAB FOR THE TREATMENT OF RECURRENT HIGH-GRADE MENINGIOMA
Authors: Nancy Ann Oberheim Bush, Karishma Kumar, Jane Rabbitt, Mariza Daras, Penny Sneed, Lauren Boreta, Jean Nakamura, Nicolas Butowski, John DeGroot, David Raleigh, Steve Braunstein
Journal: Neuro-Oncology (2024)

Abstract Recurrence of higher-grade meningioma after initial resection and radiotherapy is frequent and associated with high rates of morbidity and mortality. Salvage therapies have limited efficacy and average survival after recurrence is approximately 5-10 years. We report here preliminary data from a phase 2 study combining immunotherapy with checkpoint inhibition with stereotactic radiosurgery for treatment of recurrent high-grade meningioma (NCT04659811). Adult patients with either grade 2 or 3 meningioma who have recurred despite treatment with surgery and radiation and who meet eligibility criteria received stereotactic radiosurgery, in 1 to 5 fractions, in conjunction with pembrolizumab 200mg on the first day of radiation and then every 3 weeks until progression, unacceptable toxicity or for 2 years. Primary objective is PFS12, and secondary objectives include safety of the combined treatment in recurrent meningioma, mOS, mPFS, and neurocognitive function and QOL metrics. To date we have enrolled 18 of planned 37 patients, 33% female, 39% grade 2 and 61% grade 3. Safety lead in was completed without any dose limiting toxicity. There have been 4 SAEs, only one of which was related to study treatment (cerebral edema). 29% of patients had at least one AE, the most common were GI disorders (23%), skin disorders (23%) and headache (17%). Preliminary data from 12 patients shows PFS12 to be 50%, which suggests that the combination of stereotactic radiosurgery may be more beneficial than treatment of Pembrolizumab alone (mPFS 7.6 months). One patient was found to have a homozygous focal deletion of the MLH1 gene and had a dramatic reduction in size of her meningioma with a durable response for over one year. These preliminary data suggest that the combination of stereotactic radiosurgery and pembrolizumab is safe, well tolerated and may be beneficial to patients with recurrent higher-grade meningioma.
TMOD-04. SAFETY AND EFFICACY DATA FROM A CLINICAL TRIAL OF SONODYNAMIC THERAPY WITH 5-ALA HCL ORAL SOLUTION AND CV-01 DELIVERED WHOLE HEMISPHERIC LOW-INTENSITY NON-ABLATIVE ULTRASOUND IN PET FRENCH BULLDOGS WITH<i>DE NOVO</i> NATURALLY OCCURRING HIGH-GRADE GLIOMA
Authors: G Elizabeth Pluhar, Susan Arnold, Jeremy Ling, Matthew Hunt, Vijay Agarwal
Journal: Neuro-Oncology (2024)

Abstract To date, no animal model has been able to accurately test emerging therapeutics for high-grade glioma. Pet dogs’ high-grade gliomas closely mimic human tumors histopathologically and radiologically as well as with poor clinical survival. Dogs with these tumors have notably shorter survival than humans, with French Bulldogs showing the shortest survival of all breeds affected, aiding swift therapeutic evaluations. We report the first use of the novel CV-01 device delivering non-ablative low-intensity diffuse ultrasound (LIDU) with oral 5-ALA as a recurrent high-grade glioma treatment in a veterinary safety and efficacy trial. This Phase 1 study focused on safety, with secondary outcomes assessing histopathological efficacy markers (CC3, Iba1) and overall survival. After one SDT treatment pre-resection, treatments every 3-4 weeks were administered to eight French Bulldogs, totaling 60 administrations (average of 7.5 total treatments/patient). The control group matched breed, age, and histopathologic diagnosis. Average age was 6.35 years (range: 4.8 – 7.8 years), slightly older than controls (5.9 years, range: 3.0 - 9.9 years). No complications or toxicities were noted, and MRI scans showed no damage to the normal brain. Histopathologic analysis from four canine tumor samples revealed increased apoptosis and immune activation markers post-SDT (e.g. cleaved caspase 3 [CC3] and ionized calcium-binding adaptor molecule 1 [Iba1]), indicating selective tumor cell death. Median overall survival in the treatment group reached 205.5 days (6.8 months) compared to 55 days (1.8 months) in controls, with the longest survival at 587 days (versus 213 in controls). Although preliminary, these results affirm the safety of 5-ALA-mediated SDT in canine glioma patients. A multi-center, First-In-Human trial in recurrent high-grade glioma recently completed enrollment, aiming to further validate canine trials for emerging high-grade glioma therapeutics.
ANGI-04. DISTINCT EXPRESSION OF TARGET MOLECULES BETWEEN TUMOR CELLS IN CEREBROSPINAL FLUID AND LEPTOMENINGES FOR LEPTOMENINGEAL METASTASIS
Authors: Noriyuki Kijima, Takamune Achiha, Hideki Kuroda, Tetsuro Tachi, Koki Murakami, Haruhiko Kishima
Journal: Neuro-Oncology (2024)

Abstract PURPOSE Metastatic brain tumor frequently present with leptomeningeal metastasis. The leptomeningeal metastasis is usually diagnosed by cerebrospinal fluid (CSF) cytology and/or contrast enhanced magnetic resonance imaging. However, it remains to be known whether tumor cells from CSF faithfully represent the tumor cells of leptomeniges. Therefore, this study aimed to clarify the transcriptome differences between tumor cells from cerebrospinal fluid, and spinal cords METHODS MDA-MB-231 cells labeled with GFP and luciferase were injected into the right ventricle of immunodeficient mice. Tumor cells from cerebrospinal fluid, and spinal cords were sorted and analyzed the transcriptome differences by RNA sequencing, RESULTS RNA sequencing analysis showed distinct transcriptome profiles between tumor cells from cerebrospinal fluid and spinal cord. Genes related to ECM receptor interaction and PI3K-Akt signaling pathway such as COL1A1, COL1A2, THBS1 were significantly highly upregulated in tumor cells from spinal cord compared to those from CSF CONCLUSIONS Tumor cells from spinal cord had different characteristics in transcriptome from those from CSF. Different therapeutic strategies might be needed to regulate tumor cells from spinal cord and those from CSF.
SURG-18. INNOVATIVE DRUG-DEVICE COMBINATION FOR THE PHOTODYNAMIC TREATMENT OF PRIMARY GLIOBLASTOMA (GBM) PATIENTS
Authors: Clement Dupont, Fabienne Lecomte, Marie-Edith Bonneterre, Maximilien Vermandel, Constantinos Hadjipanayis
Journal: Neuro-Oncology (2024)

Abstract Despite advances in neurosurgical technology and techniques, the survival rate of GBM patients has remained relatively unchanged. The main treatments for GBM are associated with difficulties resulting from incomplete tumor resection and recurrence. In such situations, Photodynamic Therapy (PDT) is increasingly popular as an advanced therapeutic strategy, characterized by fewer side effects, minimal toxicity, and more controlled treatment. 5-aminolevulinic acid hydrochloride, (5-ALA HCl) has been used for years as a photosensitizing drug for the intraoperative visualization of GBM tumor tissue, enabling a more complete tumor resection. We demonstrated that, after such fluorescence-guided surgery, a laser light of specific 635 nm wavelength can additionally induce specific tumor cell death via the production of reactive oxygen species. This 5-ALA HCl–based PDT provides an antitumor effect within the tumor resection margins where recurrences occur in almost all patients. After performing pilot studies in over 20 patients with primary GBM, leading to positive safety and survival signals, we designed a new drug-device combination for this specific PDT procedure. It consists of Pentalafen ®, 5-ALA HCl administered orally to the patient before surgery, combined to Heliance®, a balloon device, inflated intraoperatively into the resection cavity, and connected to a controller (laser system) via an optical fiber to produce the light that illuminates the resection margins. A dedicated algorithm enables the duration of the illumination to be automatically computed from the tumor volume. This procedure adds an average of 30 minutes to the neurosurgery and can thus be fully integrated into the standard of care for primary GBM. This new drug-device combination is currently evaluated in a US phase 1 trial (NCT05736406) evaluating the feasibility of different light regimen treatments with the aim of delaying GBM recurrence and improving overall survival. If data is confirmed, it could be applicable to other CNS and solid tumors.
BIOS-02. DIFFERENT GROWTH PATTERN OF VESTIBULAR SCHWANNOMAS IN NEUROFIBROMATOSIS TYPE 2 PATIENTS ACCORDING TO AGE
Authors: Ho Kang, So Young Ji, Kihwan Hwang, Chae-Yong Kim, Jung Ho Han
Journal: Neuro-Oncology (2024)

Abstract The natural growth pattern of vestibular schwannoma (VS) associated with the rare disease neurofibromatosis type 2 (NF2) has not been sufficiently elucidated, and the rationale for proactive treatment for VS in NF2 is not firmly established. This study aimed to uncover the growth pattern of VS associated with NF2 and identify risk factors for rapid growth. A total of 68 VSs from 41 NF2 patients who were diagnosed in Seoul National University Bundang Hospital from July 2006 to July 2023 were retrospectively reviewed. NF2 was clinically diagnosed according to the Manchester criteria. The mean age was 34±16 years (mean ± standard deviation) at diagnosis. The initial tumor volume was a median of 0.263 cm³ (interquartile range [IQR], 0.053-0.754 cm³), and 51 VSs exhibited serviceable hearing classified as Gardner-Robertson grade 1 or 2. Patients were followed for a median of 45 months (IQR, 30-80 months), during which the median volume increased by 0.145 cm³ (IQR, 0.020-0.783 cm³), representing an annual growth rate of 0.044 cm³/yr (IQR, 0.003-0.202 cm³) or 12.4%/yr (IQR, 2.2-27.5%). Patients younger than 25 years (15 patients with 28 VSs) had significantly smaller initial tumor sizes (0.170 cm³ [IQR, 0.031-0.339 cm³] vs. 0.510 cm³ [0.099-1.399 cm³]) but faster tumor growth rates (annual growth rate; 27.3%/yr [IQR, 11.3-81.4%/yr] vs. 4.7%/yr [IQR, 0.0-16.1%/yr]) compared to those 25 years or older (26 patients with 40 VSs). Among the 51 VSs with serviceable hearing at diagnosis, 40 VSs were followed up for more than 12 months. Among them, 13 (32.5%) experienced unserviceable hearing deterioration at a median of 58 months. The risk of hearing loss significantly increased with faster tumor growth rates. The growth rate of NF2-related VS was higher in patients under the age of 25, which may be helpful in determining indications for proactive treatments like radiosurgery for NF2-related VS.