tbuckley/cabot-search huggingface dataset:
P18.27.B INTRAOPERATIVE PHOTODYNAMIC THERAPY IN COMPLEX TREATMENT OF MALIGNANT GLIOMAS
Authors: A Rynda, D Rostovthev, V Olyushin
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Treatment of malignant gliomas is an extremely difficult objective associated with difficult choice of correct strategy. Photodynamic therapy is still not the treatment standard in these patients although this approach significantly improves treatment outcomes in surgery of gliomas. To demonstrate the possibilities of chlorin e6-mediated photodynamic therapy for malignant glial tumors. MATERIAL AND METHODS There were 161 patients with malignant supratentorial glial tumors who were treated at the Polenov Russian Neurosurgery Institute between 2009 and 2016. Eighty patients comprised the main group (photodynamic therapy), 81 ones — control group (without photodynamic therapy). RESULTS Photodynamic therapy in complex treatment of malignant brain gliomas significantly increases overall survival in patients with Grade III gliomas up to 39.1±5.5 months (control group — 22.8±3.3 months) and Grade IV gliomas up to 20.7±4.7 months (control group — 13.5±2.3 months) (p=0.0002). This method also increases relapse-free period in patients with Grade III gliomas up to 21.7±3.4 months (control group — 15.8±3.1 months) (p=0.0002) and Grade IV gliomas up to 11.1±2.1 months (control group — 8.0±2.3 months) (p=0.0001). CONCLUSION Considering our own and literature data, we can conclude that PDT in complex therapy of malignant gliomas improves long-term outcomes. This is partly achieved through higher resection quality due to inclusion of pathogenetic mechanisms of PDT affecting residual tumor cells. Therapeutic effect of PDT on tumor tissue differs significantly from the mechanisms of radio- and chemotherapy. Moreover, PDT does not complicate radio- and chemotherapy, but only potentiates the overall therapeutic effect. PDT has no systemic negative effects unlike adjuvant methods such as radio- and chemotherapy.
P27.30.B VALIDATING THE NEUROLOGIC ASSESSMENT IN NEURO-ONCOLOGY SCALE FOR VIRTUAL VISITS: A PILOT STUDY
Authors: K Roberto, I Granovskaya, A Chan, A Theriault, S Mitchell, J Perry, L Nayak, M Lim-Fat
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND The Neurological Assessment in Neuro-Oncology (NANO) scale is a tool used to objectively assess nine clinically relevant domains of neurological function in patients with brain tumors to complement radiographic assessment and other clinician and patient-reported outcomes. Virtual visits for brain tumor patients are feasible and can improve clinical trial access for patients. The use of NANO in virtual care has not been validated, and we aim to determine whether a virtual NANO (vNANO) assessment is a feasible and reproducible alternative to in-person NANO for patients with glioblastoma. METHODS The study is a single-centre prospective study designed to evaluate and validate a modified NANO assessment for virtual visits. Instructions for the vNANO assessment were formulated and verified by 4 different neurologists including 3 neuro-oncologists and 1 expert in virtual neurological care. As part of the study design, a virtual visit is scheduled within one week of the routine standard of care in-person clinic visit and is done over Zoom for Healthcare. vNANO is performed independently using the vNANO scorecard by two providers sequentially and separately to assess inter-observer variability. Both evaluators are blinded to the MRI results to limit bias. An in-person visit is scheduled within one week of vNANO, and a NANO is performed by the same first provider to assess intra-observer variability. The duration of the virtual and in-person assessments are captured. Patients and clinicians are asked to complete a telehealth satisfaction survey at the end of the in-person visit. The primary endpoints are to demonstrate that 1) an adapted vNANO assessment is feasible and 2) to determine inter- and intra-observer concordance between in-person and vNANO. The secondary endpoint is to assess patient and clinician satisfaction with virtual versus in-person visits. RESULTS Sixty patients with glioblastoma will be enrolled in the study and accrual is ongoing at the time of submission (&amp;gt; 18 years old, English-speaking, KPS &amp;gt; 60). Preliminary results indicate that vNANO is time efficient and feasible with all patients completing the vNANO assessments without significant logistical or technological difficulties to date. CONCLUSION Our study will compare in-person and virtual NANO assessments in glioblastoma patients. If validated, vNANO may be adopted for virtual visits in the context of clinical trials for glioblastoma patients. The study is funded by the Academic Health Science Centre Alternative Funding Plan Innovation Fund.
P27.31.B VENOUS THROMBOEMBOLISM IN GLIOBLASTOMA POPULATION. INCIDENCE, RISK FACTORS AND SURVIVAL ANALYSIS
Authors: G Meca Santamaria, S Comas Antón, A Hernandez Gonzalez, M Domenech Viñolas, C Izquierdo Gracia, R Muriel Sanchez, C Hostalot Panisello, P Teixidor Rodriguez, B Gutierrez Garcia, J Molero Savall, S Villà Freixa
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Patients diagnosed with Glioblastoma (GB) are at an increased risk of developing venous thromboembolism (VTE) compared to other cancers. This is a relevant clinical concern due to its associated comorbidity and risk of mortality. We analyzed the incidence and characteristics of symptomatic VTE in a cohort patient diagnosed with GB. MATERIAL AND METHODS A cohort of patients diagnosed and treated for GB between 2009 and 2023 were retrospectively analyzed. Patient-, tumor- and treatment-related variables were evaluated in order to determine risk factors for VTE development as well as the impact on survival. RESULTS Forty-seven (16.84 %) out of 279 patients developed symptomatic VTE. In 38.3% of patients, it was presented as deep vein thrombosis (DVT), in 14.9% as pulmonary thromboembolism, and 46.8% presented both events synchronously. DVT were located in the lower extremity in 94.8% of cases. The periods at greatest risk of VTE were the course of adjuvant Temozolomide (29.8% of events) during rescue treatment after relapse (25.5%) and the 4-week window between the end of radiotherapy and the start of adjuvant temozolomide (19,2%). No statistical impact on VTE development was found according to sex, age, pMGMT methylation status; Karnofsky performance status (≤70% versus &amp;gt;70%), presence of paresis and type of surgery. Neither the presence of one, two or more than three cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, heart disease, tobacco) were related to a higher risk of VTE. Median overall survival (OS) and relapse free survival (RFS) were 13,8 (95% CI 12,5-16,4) and 7,3 (95% CI 6,6-8,2) months respectively for all patients. The development of VTE did not show an impact in OS nor RFS. Among patients who developed EVT, the need for dexamethasone coverage at the time of the event resulted in a decreased median OS (21,8 vs 12,9 months; p&amp;lt;00.5) and RFS (15,7 vs 7,2 months; p&amp;lt;00.5). CONCLUSION In our sample, clinical features related to the patient, treatment or tumor were not associated to an increased risk of VTE and the occurrence of VTE did not impact survival. Despite these results, the development of VTE is associated with potential increased comorbidity and mortality, so it must be considered as relevant from the clinical and health management point of view. The increased risk of thromboembolic events in patients with GB compared to other neoplasms requires further study of biomarkers to identify those patients at higher risk in order to consider the need of VTE prophylaxis.
P18.34.A PTEN ALTERATION AS A PREDICTOR OF SECOND-LINE EFFICACY IN PATIENTS WITH RECURRENT IDHWT-GLIOBLASTOMA
Authors: E Cella, M Polano, M Padovan, A Bosio, M Caccese, M Corrà, G Cerretti, E Bennicelli, G Toffoli, G Lombardi
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Patients with rGBM have a dismal prognosis. Nitrosoureas (NS) such as lomustine and fotemustine and antiangiogenic drugs such as regorafenib(Reg) and bevacizumab (Bev) are all treatment options for rGBM. No clinical or molecular factors have been validated as predictors of efficacy to second-line therapy. PTEN mutations are common in GBM, but their potential predictive role has been understudied. We aim to investigate the impact of pathogenic PTEN alterations on the efficacy of different second-line therapies in rGBM patients. MATERIAL AND METHODS We conducted a retrospective single-institution study to assess the combination of pathogenic PTEN alterations (FoundationOne®CDx on tissue), and clinical data (molecular and histological characteristics, treatment details and outcomes) in a cohort of consecutive patients with first rGBM treated with Reg, NS or Bev alone at Veneto Institute of Oncology (Padua, Italy) from Oct 2019 to Jan 2023. WHO2021 classification was used for pathological diagnosis, and RANO criteria for neuroradiologic response evaluation. RESULTS 153 patients were enrolled, treated with Reg (n=95), Bev (n=19), NS (n=39). The mOS from the start of treatment was, respectively: 12m (95% CI 9.1-14), 7.0m (95% CI 6.0-11) and 8.0 months (95% CI 5.0-13) PTEN was altered in 58 pts (61%) treated with Reg, 8 pts (57%) with Bev, in 23 pts (58%) with NS. In univariate analysis PTEN alteration was associated with short survival in Reg cohort (mOS of 10.4 m VS 16.8 m alterated versus wt PTEN, respectively; HR 1.68, p=0.043) and Lomustine cohort (mOS of 6.0m VS 16m in alterated versus wild-type PTEN, respectively; HR 1.27, p=0.01). In contrast, in Bev cohort PTEN alteration did not reach a statistical significance in univariate analysis. Of note, in multivariate analysis adjusted for categorical age (threshold,65 yrs), second surgery, ECOG score (0-1 vs. 2) and steroid use. PTEN alteration maintained a significant impact as predictor of short survival after treatment for both regorafenib and lomustine cohort (HR 1.67, p=0.043 and HR=3.17, p=0.003, respectively) together with MGMT methylation status (HR 0.44, p=0.002 and HR=0.33, p=0.006, respectively). CONCLUSION We concluded that pathogenic PTEN alteration may be a predictor of poor efficacy of regorafenib and lomustine in rGBM patients. However, a prospective study with a larger population is needed to better define the role of PTEN.
P27.27.A TUMOR TREATING FIELDS (TTFIELDS) THERAPY IN PATIENTS WITH GLIOBLASTOMA: LONG-TERM SURVIVAL RESULTS FROM TTFIELDS IN GERMANY IN ROUTINE CLINICAL CARE (TIGER) STUDY
Authors: O Bähr, G Tabatabai, R Fietkau, R Goldbrunner, M Glas
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Tumor Treating Fields (TTFields) therapy has demonstrated significant improvements in overall survival (OS) and progression-free survival (PFS) when applied with adjuvant temozolomide (TMZ) compared to TMZ alone in newly diagnosed glioblastoma (ndGBM). TTFields therapy delivers electric fields, through scalp-placed arrays, that disrupt cellular processes critical for cancer cell viability, is CE marked for WHO grade 4 glioma, and is a recommended treatment regimen for ndGBM. TTFields therapy was administered to &amp;gt;25,000 patients, showing no systemic toxicities and mild to moderate skin reactions being the main therapy-related adverse event. Here, we report survival and safety data from the TIGER study, the largest prospective study investigating real-world use of TTFields therapy during routine clinical care in patients with ndGBM in Germany. MATERIAL AND METHODS TIGER (NCT03258021), a prospective, non-interventional, multicenter, medical device study, screened patients ≥18 years of age with histologically confirmed ndGMB from August 2017 to November 2019 in 81 participating centers in Germany who had clinical indication for TTFields therapy and were within the first 3 cycles of maintenance chemotherapy treatment. The analysis presented here focuses on patients that accepted TTFields therapy. Endpoints included OS, PFS, safety, and quality of life. RESULTS In this study, 710 assessed patients agreed to participate, with 583 (82%) opting for TTFields therapy, and 429 actually commencing the treatment. This patient population represents typical GBM patients, with a median age of 58 (range 19-82) and 64.1% being male. After a total follow-up of 56.2 months, the median OS and PFS were 19.6 months (95% CI, 17.9-22.4) and 10.2 months (95% CI, 9.4-11.4), respectively. The corresponding 1, 2, 3, and 4-year OS rates stood at 79.2%, 42.4%, 31.5%, and 27.7%, while the PFS rates were 42.0%, 23.2%, 19.9%, and 17.6%, respectively. Serious AEs were observed in 68% of patients, with only 0.5% being attributed to TTFields therapy. CONCLUSION TIGER is the largest prospective study to date on routine clinical practice in ndGBM. It reaffirms TTFields therapy’s positive safety profile, and its OS and PFS survival benefits are consistent with prior reports. It also reveals promising long-term survival rates.
P22.17.B THE NEURO-ONCOLOGICAL CAREGIVER ROLES AND RESPONSIBILITIES - A QUANTITATIVE SURVEY
Authors: V R Smith, S S Kjærgård, K Piil
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND In Denmark, cancer treatment is increasingly offered on an outpatient basis. This adds a responsibility on the caregivers, who often handle treatment agreements, provide 24/7 care, and offer practical support within the home environment. Especially, caregivers of individuals with brain cancer due to the disease’s unique characteristics, including cognitive and physical alterations. Qualitative exploration of the caregiver role has been undertaken, but there remains a notable absence of quantitative measurements regarding the burden faced by neuro-oncological caregivers. Therefore, this study aimed to quantitatively investigate the impact of caregiving on individuals caring for brain cancer patients. MATERIAL AND METHODS A cross-sectional study was conducted. The questionnaire used was the validated and standardized questionnaire “Caregiver roles and responsibilities scale” (CRRS). It consists of 51 questions grouped into 6 core areas: Support and Impact, Lifestyle, Emotional Health and Well-being, Self-care, Financial situation, and Work and Career. Responses are scored on a 5-point Likert scale ranging from 0 (“not at all”) to 4 (“very much”). The CRRS questionnaire has an official scoring guideline that calculates a score ranging from 0-152, in which 0 accounts for the most burdened, and 152 the least burdened. However, there isn’t a specific cut-off score to indicate when the CRRS score should raise concern. The questionnaire was distributed for two weeks to all caregivers attending the neuro-oncology outpatient clinic at Rigshospitalet. RESULTS Included were 27 primary caregivers (out of 30 eligible). 64% were female, and age was categorized in under 65 (younger) and over 65 (older); with a range from 39 to 80 years old. Data indicated that the younger caregivers (CRRS score = 87), those being in the initial 6 months of the disease (CRRS score = 85), and those receiving minimal to no practical assistance from family and friends (CRRS score = 90) were at a higher risk of burden, compared to those being older (CRRS score = 103), in the stage of 12-24 month post-diagnose (CRRS score = 106) and who received moderate to substantial support (CRRS score = 101). 18% of women rated their physical health as impaired to a large degree due to the patient’s disease, and none of the men noted this. CONCLUSION The CRRS questionnaire could serve as a valuable screening tool to identify the specific support required by individual caregivers. The study indicates that female caregivers under the age of 65, particularly within the initial 6 months of the disease onset, and those lacking practical support from friends and family, tend to experience elevated levels of burden. The study’s findings do not specify the frequency or timing for administering the CRRS questionnaire as a screening tool, initial steps could involve integrating the screening process within the first six months of caregiving.
P18.37.B REPEATED CONVECTION-ENHANCED DELIVERY (CED) INFUSION OF A POLIO/RHINOVIRUS RECOMBINANT (LERAPOLTUREV; LERA) IN RECURRENT GLIOBLASTOMA (RGBM) PATIENTS, FOLLOWED BY CERVICAL PERILYMPHATIC INJECTIONS OF LERA (LERA-CPLI)
Authors: A Desjardins, M Brown, M Shoaf, J E Herndon II, M O Johnson, M Khasraw, J Low, K B Peters, K Batich-Vaios, A H Friedman, H S Friedman, D M Ashley, D D Bigner, M Gromeier
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Phase 1 and 2 clinical trials of a single intratumoral injection of LERA (previously PVSRIPO) via CED into enhancing disease of rGBM has been shown safe and prolonged survival was observed in a subgroup of patients. We are now proposing a clinical trial investigating repeated infusions of LERA via CED into the residual infiltrative disease following maximal safe resection of the enhancing component, followed by LERA-CPLI. In animal models, repeated intratumoral LERA infusions enable infection of dendritic cells (DCs) recruited by LERA, maximizes engagement of tumor-associated and CNS-resident myeloid compartments, and thus optimizes the conditions for LERA-induced tumor immune surveillance. Furthermore, preclinical data in two established cancer models support the use of LERA-CPLI to augment intratumoral therapy. MATERIAL AND METHODS Eligibility includes adult patients with a solitary supratentorial rGBM amenable to resection followed by CED infusion of LERA; ≥4 weeks after chemotherapy, bevacizumab or study drug; adequate organ function; and KPS&amp;gt;70%. Patients undergo maximal safe resection of the enhancing component, followed three weeks later by two, 4-day apart, CED infusions of LERA in the residual non-enhancing disease. One week later, patients initiate four weekly injections of LERA-CPLI, followed by LERA-CPLI every 3 weeks for one year. RESULTS As of 5/01/2024, three pilot patients have been treated under expanded access protocols and have completed 6, 11, and 17 LERA-CPLI, respectively, following two intracerebral LERA injections via CED. Study related adverse events include grade 1 fatigue (n=2) and grade 1 headache (n=1). CONCLUSION Repeated CED infusions of LERA followed by LERA-CPLI in three pilot rGBM patients has been shown safe and feasible. Updates on the formal trial proposed to enroll up to 86 patients will be provided.
P18.07.B BEVACIZUMAB ALONE VERSUS BEVACIZUMAB PLUS IRINOTECAN IN PATIENTS WITH RECURRENT GLIOBLASTOMA: A NATION-WIDE POPULATION-BASED STUDY
Authors: S Kim, Y Lee, E Lee, T Roh
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND This study was aimed to compare the survival of patients with recurrent glioblastoma who received bevacizumab monotherapy (BEV) and those received bevacizumab plus irinotecan combination therapy (B+I) by using a nationwide population-based dataset. MATERIAL AND METHODS We screened patients matching the International Classification of Diseases code C71.x were screened from the Health Insurance Review and Assessment Service database, and selected patients who underwent surgery or biopsy from January 2008 to November 2021 and subsequent standard concurrent chemoradiation with temozolomide. Among them, those who received BEV or B+I were included in this study. Demographic characteristics, in-patient stay, prescription frequency, survival outcomes, and steroid prescription duration were compared between these two groups. RESULTS Out of a total of 846 patients, 450 and 396 received BEV and B+I, respectively. The BEV group had a higher percentage of women (50.22%) than in the B+I group (42.68%). The mean age of the BEV group (54.50 years) was higher than that of the B+I group (51.98 years). However, there were no significant intergroup differences in the numbers of radiation and adjuvant temozolomide therapy cycles. The median overall survival from the initial surgery was 22.60 months (95 % CI: 20.50-24.21) and 20.44 months (95 % CI: 18.55-22.60), and there was no significant difference in survival outcomes between the groups (P = 0.5079, log-rank test). CONCLUSION There was no significant difference in overall survival between the BEV and B+I groups in this study. Considering the additional potential toxicities associated with irinotecan, bevacizumab monotherapy could be a suitable treatment option for patients with recurrent glioblastoma. To further substantiate these findings, additional prospective randomized trials are necessary.
P22.18.A THE SEVERITY OF ANXIETY AND DEPRESSION SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH LOW-GRADE GLIOMAS
Authors: A Olejnik, A Bala, T Dziedzic, A Marchel, P Kunert
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Depression, anxiety, and reduced quality of life are frequent problems in patients with brain tumors. Objective of the current study was to examine quality of life level and its correlation with different clinical and demographic factors among patients diagnosed with Low Grade Gliomas (LGG). MATERIAL AND METHODS The study involved 55 individuals with a possible diagnosis of low-grade glioma based on MRI examination. The final analysis included only the data collected from 48 patients whose diagnosis of LGG was confirmed by histological and genetic examination, as well as 48 demographically matched healthy control individuals. Before the surgical procedure, when neither the histological nor the genetic diagnosis had been established, each patient filled out a questionnaire to ensure the outcomes would not be affected by this information. The Hospital Anxiety and Depression Scale (HADS), the World Health Organization Quality of Life questionnaire (WHO-QoL-BREF), and a demographic-clinical questionnaire were used in the study. RESULTS Intergroup comparisons indicated that patients with LGG reported a lower quality of life than healthy individuals (p &amp;lt; 0.05). According to the HADS scale responses, patients with LGG experienced significantly more severe depression and anxiety symptoms, than healthy individuals (p &amp;lt; 0.001). Correlational analysis revealed a significant negative correlation between almost all subscales of quality of life and the severity of depression symptoms: QoL - physical scale (p &amp;lt; 0.05), QoL - psychological scale (p &amp;lt; 0.05), QoL - social scale (p &amp;lt; 0.05). Additionally, older patients reported a poorer quality of life compared to younger patients. The gender of the participants did not correlate with the quality of life. CONCLUSION Patients with LGG experience a decline in quality of life. Objective neurological deficits, epilepsy, as well as awareness of the cancer diagnosis, may be associated with the occurrence of depressive and anxiety symptoms, such as low mood, loss of interest, difficulties in social functioning. Acknowledging these factors and integrating them into the care of patients with LGG is essential for providing sufficient psychological support and improving their psychological well-being. Further research is necessary to assess the quality of life of patients after surgery, to exclude the impact of stress associated with waiting for the procedure, as well as to assess potential changes in quality of life during the recovery period.