tbuckley/cabot-search huggingface dataset:
NIMG-18. RAPID INTRAOPERATIVE DIFFERENTIATION OF PRIMARY CNS LYMPHOMA FROM COMMON CNS TUMORS USING STIMULATED RAMAN HISTOLOGY AND DEEP LEARNING
Authors: David Reinecke, Nader Maroouf, Daniel Alber, Andrew Smith, Todd C Hollon, Volker Neuschmelting, John G Golfinos, Daniel A Orringer
Journal: Neuro-Oncology (2024)

Abstract Accurate intraoperative diagnosis is crucial for decision-making during tumor surgery and stereotactic-guided biopsies. Differentiating between primary CNS lymphoma (PCNSL) and non-PCNSL entities such as gliomas and metastatic cancers presents significant challenges due to overlapping histomorphological features, time constraints, and the differing further therapy strategies required. Our study utilized deep learning and stimulated Raman histology (SRH) to address this challenge. We imaged unprocessed, label-free tissue samples intraoperatively using a portable Raman scattering microscope, generating virtual H&amp;E-like images within less than five minutes. Our training set comprised over 54,000 SRH tumor patch images, including various brain tumors. We developed a deep learning pipeline utilizing a ResNet-50 feature extractor and the BYOL (Bootstrap Your Own Latent) self-supervised learning algorithm. We trained a binary linear classifier to distinguish between PCNSL and non-PCNSL entities. Data were collected from New York University (NYU), the University of Cologne (UKK), and the University of Michigan (UM), including 263 SRH whole slide images from 177 patients sourced from surgical resections and stereotactic-guided biopsies. In an international bicentric test cohort (N = 100, NYU and UKK), the model achieved an overall accuracy of 91.1%, an area under the receiver operating characteristic curve (AUROC) of 0.983, a sensitivity of 89.3%, and a specificity of 100% compared to the final formalin-fixed, paraffin-embedded-based diagnosis. Our algorithm can accurately extract typical histomorphological features to help differentiate between PCNSL and non-PCNSL tumors. These results underscore the potential of deep learning models to enhance the accuracy of intraoperative diagnoses for PCNSL and non-PCNSL entities, thereby improving intraoperative decision-making and further treatment strategies by supporting neuropathologists and surgeons.
DDDR-05. SPATIALLY RESOLVED DRUG SENSITIVITY PROFILING IN GLIOBLASTOMA
Authors: Alicia Buck, Sohyon Lee, Rebekka Wegmann, Julien Mena, Flavio Vasella, Julia Friesen, Luca Regli, Emilie Le Rhun, Anna Maria Zeitlberger, Marian Christoph Neidert, Nazanin Tatari, Gregor Hutter, Michael Weller, Berend Snijder, Tobias Weiss
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Glioblastoma is the most common malignant primary brain tumor in adults, characterized by poor overall survival and an urgent need for more effective treatment strategies. Macroscopic heterogeneity, as observed through MR imaging, divides the tumor into distinct regions: a tumor-cell dense contrast-enhancing tumor core and a non-contrast-enhancing infiltration zone that appears hyperintense on T2/FLAIR imaging. The infiltration zone contains both infiltrating tumor cells and non-malignant cells from the local brain microenvironment. Although genomic and transcriptomic differences between the tumor core and the infiltration zone have been reported, functional differences, such as differential drug sensitivities, remain largely unknown. METHODS To investigate this, we collected region-specific glioblastoma patient tissue samples from both the contrast-enhancing tumor core and the non-contrast-enhancing but 5-aminolevulinic acid (5-ALA) fluorescent infiltration zone during surgery. Using pharmacoscopy, a microscopy-based single-cell drug screening platform, we assessed drug responses across regions and patients. RESULTS To determine whether drug responses within a single tumor region were more similar compared to responses across different regions we collected multiple tissue samples from each tumor region in seven patients. We identified region-specific drug responses for temozolomide and lomustine, among other drugs, in some of the patients. However, drug sensitivities were not consistent within the same region across different patients. Thus, across patients, the region-specific drug responses were obscured by patient heterogeneity. To address intra- and inter-tumor drug response heterogeneity, we developed a complementarity score based on region-specific drug response data of 60 drugs across 23 paired samples. The complementarity score identified promising drug combinations that demonstrated strong anti-tumor activity across tumor regions and patients. CONCLUSIONS Monotherapy approaches have largely failed in glioblastoma, despite extensive molecular profiling efforts aimed at identifying tumor-specific vulnerabilities. Identifying drug combinations that synergistically target the locoregional heterogeneity of glioblastoma may open up new avenues of personalized therapy.
INNV-14. OUTCOMES OF PATIENTS WITH ISOCITRATE DEHYDROGENASE-MUTANT WHO GRADE 4 ASTROCYTOMA TREATED WITH TUMOR TREATING FIELDS (TTFIELDS) THERAPY: A REAL-WORLD ANALYSIS
Authors: Jennifer M Connelly, Nick navgeropoulos@novocure.com, Patrick Conlon, Gordon Chavez, Ori Farber
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Tumor Treating Fields (TTFields) therapy is approved for the treatment of patients with newly diagnosed glioblastoma, based on the EF-14 study which demonstrated improvement in progression free survival and overall survival (OS). EF-14 included patients with the isocitrate dehydrogenase (IDH) mutation (IDHmut), which has since been reclassified as IDHmut WHO grade 4 astrocytoma (Astrocytoma IDHmut/G4) and confers a more favorable prognosis than IDH wild type. However, large real-world datasets are lacking. Here, we report real-world outcomes of patients with Astrocytoma IDHmut/G4 treated with TTFields in the US. METHODS Utilizing electronic health records from the xCures real-world data platform, patients with newly diagnosed Astrocytoma IDHmut/G4 receiving TTFields in the US from January 1 to December 31, 2019 were analyzed and IDH-mut status was confirmed. Survival was analyzed based on IDH-mut status and TTFields usage, with patients categorized into 2 usage groups (minimum 30 days treatment): high (≥50%) and low (&amp;lt;50%) usage. RESULTS Among 1285 patients with known IDH status, 82 had an IDH-mut and were included. The median (range) age of patients was 40.6 (21–75) years, with the majority being men (n=58/71%) and with methylguanine-methyltransferase-promoter methylation (n=48/59%). Median TTFields therapy duration and usage were 9.4 months and 76.8%, respectively. OS at 2 and 4 years was 66% (95% CI: 56–77%) and 44% (34–57%), respectively. Patients with high TTFields usage had increased OS compared to low usage (HR: 0.53 [0.28–1.02], P=0.057, n=80). Among 22 patients with a minimum 4 years of survival, 5 were still on therapy as of the data cutoff. CONCLUSIONS These findings demonstrate the utility of the xCures platform in systematically assessing outcomes for a rare glioma subtype in the real-world setting, and suggests that patients with Astrocytoma IDHmut/G4 may benefit from TTFields therapy. Additional patient follow-up and correlative data will be presented.
RTID-01. ACCELERATOR-BASED BORON NEUTRON CAPTURE THERAPY, RANDOMIZED CONTROLLED TRIAL FOR RECURRENT AND REFRACTORY HIGH-GRADE MENINGIOMAS
Authors: Shin-Ichi Miyatake, Masahiko Wanibuchi, Motomasa Furuse, Naosuke Nonoguchi, Shinji Kawabata, Keiji Nihei, Koji Ono, Satoshi Takeno, Naonori Fu
Journal: Neuro-Oncology (2024)

Abstract INTRODUCTION High-grade meningiomas (HGMs) recurred after X-ray treatment showed pessimistic prognosis. We started “A phase II investigator-lead RCT using accelerator-based BNCT system for refractory recurrent high-grade meningioma”. MATERIALS AND METHODS We prepared 2 study arms, BNCT test treatment arm (12 subjects) and control best supportive care arm (6 subjects) in randomized controlled trial (RCT) fashion. PFS judged by the third-party committee was primary endpoint and PFS judged by investigators themselves and OS of BNCT arm were secondary endpoints. Rescue BNCT was permitted for control group patients, if they showed progress disease (PD). RESULTS Three and two grade 3 subjects were included in BNCT and control arm, respectively. Others were grade 2 subjects. As of March 31, 2024, 10 out of 12 in BNCT arm and all 6 cases in control arm were judged as PD. mPFS judged by investigators showed 65 and 8 weeks for BNCT and control arm, respectively (P=0.0002, Wilcoxon). Six out of 12 in BNCT and 4 out of 6 cases in the control arm were dead. OS-2 year rates of BNCT and control arms are 91.7% and 33.3%, respectively (p=0.045, Wilcoxon). Five out of 6 cases in control arm received rescue BNCT after PD assessments. With regard to best response on MRI, PR, SD were 5 and 7 cases in treatment arms (ORR was 41.7%). CONCLUSION mPFS judged by third party committee is still being closed and unknown, so far. With regard to secondary endpoints, there are marked differences in both arms in mPFS judged by investigators. Recently, the results of RCT of “Trabectedine” organized by EORTC was reported. Unfortunately there was no effect of Trabectedine not only in PFS but in OS. In our current RCT results BNCT arm is extremely excellent in comparison with EORTC RCT of “Trabectedine” both in OS and PFS.
IMMU-60. MYELOID POPULATIONS MODULATE GD2 CAR T CELL ACTIVITY IN DIFFUSE MIDLINE GLIOMA
Authors: Sneha Ramakrishna, Anna Geraghty, Zinaida Good, Moksha Desai, Rebecca Mancusi, Jasia Mahdi, Kun Wei Song, Zachary Ehlinger, Yiyun Chen, Mark Hamilton, Skyler Rietberg, Robbie Majzner, Liora Schultz, Becky Richards, Jennifer Kamens, Vali Barsan, Cynthia Campen, Sonia Partap, Jennifer Moon, Christina Baggott, Michael Kunick, Michelle Fujimoto, Amy Li, Sneha Jariwala, Sharon Mavroukakis, Emily Egeler, Ashley Jacobs, Courtney Erickson, Snehit Prabhu, Kara Davis, Steven Feldman, Bita Sahaf, Crystal Mackall, Michelle Monje
Journal: Neuro-Oncology (2024)

Abstract H3K27M-mutated diffuse midline gliomas (DMGs) are universally lethal cancers in children and young adults. Our team previously demonstrated efficacy of GD2-targeting chimeric antigen receptor T cells (GD2-CAR T-cells) in preclinical models of DMG of the pons (also called diffuse intrinsic pontine glioma (DIPG) and DMG of the spinal cord, and opened a Phase I clinical trial (NCT04196413) treating patients with first intravenous (IV) followed by repeated infusions of intracerebroventricular (ICV) GD2-CAR T-cells. We employed high-dimensional analyses to define immune states contributing to CAR-T activity in patients. Single cell RNA-sequencing (scRNAseq) was conducted on 555,406 single cells from 115 cerebrospinal fluid (CSF) samples of 13 patients before and after CAR-T treatment. This is the largest CSF CAR-T dataset in central nervous system (CNS) tumors and provides insights into the immune biology surrounding CAR-T treatment for CNS malignancies. Patient CSF samples were dominated by T cell and myeloid populations. After CAR-T infusion, patient CSF exhibited an increased fraction of regulatory T cells and myeloid populations from baseline. Myeloid cells in early timepoints after ICV administration demonstrated a unique pro-inflammatory signature, while CSF samples from IV and late ICV timepoints exhibited a suppressive signature. To further explore the immune biology of these myeloid contributors, we developed a patient-derived xenograft model of DMG relapse following low-dose ICV GD2 CAR-T treatment. Using a pharmacological CSF1R-inhibitor, we demonstrate that depletion of microglia/myeloid cells at a specific window following CAR-T administration enhances durability of tumor control. Together, these data display the power of in-depth correlative analyses to identify distinct immune populations that drive durability of response. Key findings from these data will allow for optimization of CAR-T therapies for H3K27M+ DMG patients, providing hope to shift the paradigm of this fatal disease.
CTNI-35. EVALUATE THE SAFETY AND PRELIMINARY EFFICACY OF THE COMBINATION OF NAVIFUS SYSTEM WITH RE-IRRADIATION FOR RGBM PATIENTS
Authors: Kuochen Wei, Koting Chen, Chiungyin Huang
Journal: Neuro-Oncology (2024)

Abstract The blood-brain barrier (BBB) remains the major obstacle in treating patients with malignant brain tumors. Radiation therapy (RT) is the mainstay adjuvant modality regardless of the BBB, but its effectiveness is hindered by the hypoxic microenvironment. Focused ultrasound (FUS) combined with systemic microbubbles has been shown to open the BBB and potentially increase regional perfusion. However, no clinical study has investigated the combination of RT with FUS-BBB opening (RT-FUS). Here, we report an interim analysis of an ongoing single-arm, prospective, pilot study (NCT04988750) combining RT-FUS for recurrent malignant high-grade glioma patients, where re-RT was considered for disease control. FUS-BBB opening was conducted within 2 hours before RT. Treatment responses were evaluated by objective response rate (ORR) using magnetic resonance imaging, progression-free survival, overall survival, and adverse events (AEs). In this pilot clinical trial, an interim analysis of six recurrent malignant high-grade glioma patients who underwent a total of 24 RT-FUS treatments was presented. Three patients experienced rapid disease progression after RT-FUS, while the other three patients had at least stable disease after RT-FUS, with or without salvage chemotherapy or targeted therapy. There were no FUS-related AEs, but re-RT-related grade three radiation necrosis was observed. The interim analysis of this ongoing clinical trial showed that the combination of RT-FUS was safe, with no FUS-related adverse effects. Two more cases will be recruited in this trial. A comprehensive analysis of radiation dosimetry and FUS energy distribution is expected after completing the final recruitment.
CTNI-15. A PERIOPERATIVE STUDY OF SAFUSIDENIB IN PATIENTS WITH IDH1 MUTATED GLIOMA
Authors: James Whittle, Mark Rosenthal, Montana Spiteri, Robert Tobler, Monique Topp, Sarah Cain, Jordan Jones, Sammy Shaya, Adam Valkovic, Oluwaseun Fatunla, James Dimou, Samuel Roberts-Thomson, David McArdle, Elaine Lui, Brunda Nijagal, Camilla Mitchell, Sean Grimmond, Sarah Best, Saskia Freytag, Kate Drummond
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND IDH mutations cause aberrant accumulation of (R)-2-hydroxyglutarate (2-HG), an oncometabolite that promotes tumorigenesis through abnormal hypermethylation of histones and DNA as well as suppression of normal cellular differentiation. IDH inhibition significantly improves progression free survival in patients with IDH mutant WHO grade 2 glioma, however most patients progress, and there is a lack of understanding on mechanistic reasons for failure. METHODS We tested Safusidenib, an oral, blood brain barrier penetrant IDH1 R132X enzyme inhibitor in a single arm, open label perioperative study. Patients with IDH1 mutated glioma, treatment naïve to radiation or chemotherapy, received Safusidenib (250 mg BID) for four weeks following surgical biopsy and prior to definitive resection (Part A). After resection patients continued Safusidenib until toxicity or progression (Part B). Translational endpoints include paired whole genome transcriptome sequencing (WGTS), single nuclei RNA sequencing (snRNAseq), spatial transcriptomics and spatial metabolomics as well as longitudinal sampling of blood and CSF for circulating tumour DNA (ctDNA). Here we are reporting Part A of the study. RESULTS As of May/27/2024 10 patients (mean age 37, 40% female) have been enrolled: seven with astrocytoma, three with oligodendroglioma; six had prior surgical resection. Pharmacokinetic sampling showed a mean tumor concentration 2457 ng/mL (range 957.0 – 4810) with tumor:plasma ratio 0.33. Consistent with mechanism, tumor 2-HG reduced 86% from biopsy (mean 75.0μM, range 7.8-203) to surgery (10.3μM, range 2.3 – 30.8), as well as identification of novel biomarkers of response. Paired tumour snRNAseq reveals transcriptional shift with changing cell-to-cell communication, and increased immune infiltration post-treatment, validated by spatial transcriptomics. Additionally, we find reduced heterogeneity consistent with a more differentiated tumour state. Treatment was well tolerated with ongoing follow-up. CONCLUSIONS This innovative trial facilitates intra-patient comparisons and confirmation of the on-target effects of Safusidenib, enhancing understanding of the mechanisms of response and resistance. The approach serves as a proof of concept for advancing drug development in glioma through perioperative trials.
RADT-37. PROTON THERAPY REIRRADIATION FOR RECURRENT MALIGNANT GLIOMA: PROSPECTIVE ANALYSIS FROM THE PROTON COLLABORATIVE GROUP
Authors: Omer Gal, Stephen Mihalcik, Jing Zeng, John H Chang, Lane Rosen, Isabelle Choi, Charles B Simone, Carlos E Vargas, Henry K Tsai, Robert H Press
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Standard of care treatment for recurrent malignant glioma after prior radiotherapy (RT) is not well established. Proton therapy (PT) is increasingly used for reirradiation (ReRT) at the time of recurrence; however, treatment outcomes, toxicity, and prognostic factors for patients treated with PT-ReRT remain poorly defined. METHODS The prospective, multi-institutional Proton Collaborative Group (PCG) registry was queried for patients with malignant glioma who previously received RT and underwent PT-ReRT between 7/2011-12/2023. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method, and Cox proportional hazards regression was used for uni- and multivariate analysis (UVA and MVA). Dose was calculated using equivalent dose in 2-Gy fractions (EQD2). RESULTS 143 consecutive patients were identified. Median follow-up was 11.2 months and median time interval (TI) from prior RT (median 58.5 Gy) to PT-ReRT (median 44.6 Gy) was 42.4 months. Primary histology was glioblastoma (n=74), astrocytoma (n=35), and oligodendroglioma (n=34). Median PFS and OS were 8.1 and 11.2 months, respectively. On UVA, improved OS was associated with oligodendroglioma (HR 0.37) and astrocytoma histology (HR 0.53) compared to glioblastoma, TI &amp;gt;60 months (HR 0.2), CNS WHO Grade 2 compared to 4 (HR 0.42), and ECOG performance status 0 (HR 0.47). On MVA, improved OS remained associated only with oligodendroglioma (HR 0.42) and TI &amp;gt;60 months (HR 0.49). Acute and Late Grade 3 toxicity occurred in 7% and 4% of patients. Acute Grade 3 toxicity was associated with poor performance status (HR 16.15). CONCLUSIONS In the largest series of glioma PT-ReRT reported to date, retreatment appears well tolerated with variable outcomes based on clinical prognostic factors. Toxicity rates were acceptable compared to historical photon-based literature despite a high median prescription dose.
TMET-25. WILD-TYPE IDH1 INHIBITS FERROPTOSIS IN GLIOBLASTOMA
Authors: Madeline Dunterman, Navyateja Korimerla, Kevin Murnan, Serena Tommasini-Ghelfi, Daniel Wahl, Alexander Stegh
Journal: Neuro-Oncology (2024)

Abstract De novo lipogenesis and the defense against oxidative lipid damage require large amounts of cytosolic NADPH. Our group has recently found that glioblastoma (GBM) up-regulate wild-type Isocitrate dehydrogenase 1 (referred to hereafter as ‘wt-IDH1high GBM) that, through oxidative decarboxylation of isocitrate, generates large quantities of alpha-ketoglutarate and cytosolic NADPH. We demonstrated that RNAi-mediated knockdown of wt-IDH1, alone and in combination with RT, slows the growth of patient-derived HGG xenografts, while overexpression of wt-IDH1 promotes intracranial HGG growth. Here, we demonstrate that wt-IDH1high GBM produce excess NADPH, which is a rate-limiting reductant that drives de novo fatty acid biosynthesis. Isotope tracer and liquid chromatography-based lipidomic studies indicate that wt-IDH1 supports the de novo biosynthesis of mono-unsaturated fatty acids (MUFAs), promotes the incorporation of monounsaturated, and reduces the abundance of oxidizable polyunsaturated (PUFA) phospholipids in the cell membrane. Conversely, the genetic ablation of wt-IDH1 or the pharmacologic inhibition of wt-IDH1 in tumor cells, using a brain-penetrant wt-IDH1-specific small molecule, revealed a significant increase in PUFA-containing lipid species harboring oxidized arachidonic tails. Of note, two lipid species, (PE16:0_20:4) and (PE18:0_22:4), previously reported to act as substrates for 15-lipoxygenase (15-LOX) - a key enzyme that facilitates lipid peroxidation - are enriched in tumor cells with wt-IDH1 compromise. Further, we found that the enhanced NADPH production in wt-IDH1high GBM, together with heightened biosynthesis of carbon precursors required for glutathione biosynthesis, increased levels of reduced glutathione (GSH), activate the phospholipid peroxidase glutathione peroxidase 4 (GPX4)-driven lipid repair pathway, which scavenges PUFA-containing lipid peroxides, known executioners of ferroptosis. These findings support elevated wt-IDH1 expression, the ensuing effect on the tumor lipidome, redox homeostasis, and protection against lipid peroxidation as contributors to GBM tumor growth and therapy resistance and point to the inhibition of wt-IDH1 as a ferroptosis-inducing strategy for the treatment of GBM.
CTIM-12. A RETROLECTIVE ANALYSIS ON THE SAFETY, EFFICACY AND IMMUNOGENICITY OF 203 GLIOBLASTOMA PATIENTS TREATED WITH PERSONALIZED THERAPEUTIC CANCER VACCINES (PTCV)
Authors: Pauline Latzer, Henning Zelba, Florian Battke, Oliver Bartsch, Annekathrin Reinhardt, Eike Pertuch, Borong Shao, Armin Rabsteyn, Thomas Okech, Alexander Golf, Christina Kyzirakos-Feger, Simone Kayser, Magdalena Feldhahn, Julian Wünsche, Dirk Hadaschik, Dieter Götte, Saskia Biskup
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor. Despite of the current SoC, patients have a poor prognosis with a median OS of about 14-17 months.Method, RESULTS We report retrospectively analyzed data from 203 GBM patients (IDH wildtype) who added PTCV derived from patient individual tumor mutations to their treatment regimen in the setting of individual treatment attempts (ITA) in Germany. Data were analyzed re. vaccine induced T cell responses and safety acc. to CTCAE terminology version 5.0. Subsets of patients with and without hypermethylation of the MGMT promoter were further evaluated re. efficacy. Treated patients had a median age of 53 years at diagnosis, started vaccination after a median of 11 months after diagnosis, received a median of 8 immunizations with a median of 20 neoepitope peptides, and had a median follow-up time since first vaccination of 21 months. They usually received SoC (Stupp scheme), often accompanied by additional therapies. In general, the PTCV was well tolerated, and most patients experienced only Grade 1 and 2 AEs. Most frequently injection site reactions were observed (67%). Seven patients developed Grade 3 allergic or anaphylactic reactions after 7 or more vaccinations. For 119 patients T-cell responses against the vaccinated neoepitopes were investigated. Almost all patients developed vaccine induced T-cell responses (97%). 71% of patients showed both CD4+ and CD8+ T-cell responses towards vaccinated peptides. Immune responses usually increased over time peaking within 3-6 months. Median OS of the whole cohort was 26 mo (95% CI 24, 31). Primary GBM patients without recurrence events before the start of vaccination and with or without hypermethylated MGMT promoter status showed a mOS of 41 months (95% CI: 32, NA) or 23 months (95% CI: 20, NA), respectively. CONCLUSION The retrospective data analysis from a real-world cohort of GBM patients suggests that PTCV are safe, immunogenic, and may prolong the survival of patients.