tbuckley/cabot-search huggingface dataset:
EPCO-47. SEX-BIASED BRD4 ACTIVITY DRIVES TUMORIGENESIS IN GLIOBLASTOMA
Authors: Ruby Powell, Thomas Beaumont, Najla Kfoury-Beaumont
Journal: Neuro-Oncology (2024)

Abstract Consistent sex differences in incidence and outcome have been reported in cancers including brain tumors. Glioblastoma (GBM), the most common and aggressive primary brain tumor, occurs with higher incidence and shorter survival in males compared to females. Brd4 is essential for regulating transcriptome-wide gene expression and specifying cell identity. Using an isogenic murine GBM model, we have reported correlated transcriptome-wide sex differences in gene expression, Brd4-bound enhancer usage, and Brd4 localization to oncogenic and tumor suppressor transcription factors binding sites in male and female GBM cells, respectively. Sex-biased gene expression patterns were also evident in human glioblastoma. Inhibiting Brd4 function abrogates sex differences in these transcriptional states and concomitant differences in tumorigenic phenotype. Thus, sex-biased Brd4 activity drives sex differences in GBM rendering males and females differentially sensitive to BET inhibitors. These data indicate that Brd4 can exhibit dual functions as an oncogene or tumor suppressor, dependent upon cellular sex. To better understand how to globally target Brd4, we interrogated the role played by master transcriptional Brd4 regulators in coordinating this dual phenotype in GBM. Motif-based analysis revealed that Brd4 co-localized with oncogenes such as Bach1, and Klf5 at male-biased enhancers whereas female-biased enhancers were co-occupied with tumor suppressors, such as Smad4 and p53. Knockdown of Bach1 decreased clonogenic frequency in males and females. Conversely, knockdown of Smad4 increased proliferation and clonogenicity in males, further inducing the male tumorigenic phenotype, while no change was observed in females. These results indicate that Smad4 might be necessary but not sufficient to provide females with resistance to transformation. Ongoing epitranscriptomics investigating Brd4 re-localization and enhancer usage in knockdown cells will increase our understanding of Brd4 mechanism in GBM. Targeting sex-biased Brd4 function will identify novel combinatorial sex-specific therapeutics for brain tumors and could have immediate impact on the clinical treatment of GBM patients.
DDEL-19. DRUG-TUMOR RESIDENCE TIME DRIVES EFFICACY OF CONVECTION-ENHANCED DELIVERY IN H3 K27-ALTERED DIFFUSE MIDLINE GLIOMA
Authors: Julian S Rechberger, Jacob B Anderson, Jizhi Ge, Liang Zhang, David J Daniels
Journal: Neuro-Oncology (2024)

Abstract Advancements in understanding H3 K27-altered diffuse midline glioma (DMG) biology have not yet translated into effective therapies for these tumors likely due to delivery challenges across the blood-brain barrier (BBB) and variable tumor genetics. This study systematically probes convective-enhanced delivery (CED) as a means to administer small molecule drugs directly to DMG tumors, circumventing constraints imposed by the BBB. Our findings emphasize the necessity of strategic drug selection and pharmacokinetic analysis in refining CED approaches, advocating for precision medicine techniques specialized for DMG. We demonstrate that while most small molecule drugs are rapidly cleared from the brain following CED, their retention and effectiveness are substantially improved by co-administration of systemic efflux transporter (ET) inhibitors such as everolimus. The synergistic potential of combining everolimus with topotecan or ponatinib offers a novel therapeutic pathway, advocating for further investigation into this DMG management strategy.
EPID-10. THE INCIDENCE OF PRIMARY BRAIN TUMORS IN JAPAN IN 2016-2019
Authors: Yoshitaka Narita, Makoto Ohno
Journal: Neuro-Oncology (2024)

Abstract The national cancer registries in Japan have started since 2016 and the actual number of cancer patients in including primary central nervous system (CNS) tumors in Japan was revealed. Average number of primary CNS tumors in 2016-2019 was 29,492 and the crude incidence rate per 100,000 people (CIR) was 23.30. Malignant and benign CNS tumors was 6,696 (22.7%) and 22,796 (77.3%) and each CIR was 5.29 and 18.00, respectively. Among 29,492 tumors, 10,537 (35.7%) meningioma, 5,217 (17.7%) pituitary adenoma, 4,537 (15.4%) neuroepithelial tumor, 2,730 (9.3%) neurinoma and 1,166 (4.0%) primary CNS lymphoma (PCNSL) were reported. Regarding to malignant brain tumors, 2,071 glioblastoma, 362 astrocytoma grade II, 390 anaplastic astrocytoma grade III, 138 pilocytic astrocytoma,182 oligodendroglioma grade II, 154 anaplastic oligodendroglioma grade III, 140 ependymal tumors, 128 embryonal tumors including 91 medulloblastoma, 211 germ cell tumor (GCT) were found. CIR of neuroepithelial tumor, glioblastoma, PCNSL, embryonal tumors and GCT were 3.64, 1.68, 0.93, 0.10 and 0.17, respectively. According to the Central Brain Tumor Registry of the United States (CBTRUS) (2016-2020), CIR in the US was 26.73, and age-adjusted incidence rates of primary CNS tumors per 100,000 population in the US based on the US population in 2000 (AIR) was 24.83 and AIR in Japan was 17.15. AIR of glioblastoma in the US and Japan was 3.27 and 1.05, AIR of PCNSL was 0.44 and 0.51, AIR of embryonal tumors was 0.21 and 0.16, AIR of GCTs was 0.08 and 0.27, and AIR of meningioma was 9.73 and 5.11, respectively. This report demonstrated that the incidence of neuroepithelial tumors and embryonal tumors in Japan was approximately half to one-third, whereas that of GCTs in Japan was approximately 3 times comparing to the US.
EPID-15. INPATIENT CARE COSTS AND ASSOCIATED REIMBURSEMENTS FOR PATIENTS WITH LEPTOMENINGEAL DISEASE: A REAL-WORLD ANALYSIS
Authors: Ahmad Ozair, Alireza Mansouri, Stuart Grossman
Journal: Neuro-Oncology (2024)

Abstract INTRODUCTION Leptomeningeal disease (LMD) is an increasingly significant cause of cancer-related morbidity, mortality, and economic burden. While healthcare costs associated with brain metastases (BMs) have been well-described, minimal economic literature exists for LMD. This study sought to evaluate inpatient care costs (IPCCs) and reimbursements for LMD patients using a contemporary US claims database. METHODS This retrospective study, reported following STROBE guidelines, included adult LMD patients (aged 18-65 years) receiving inpatient care during January 2016 to December 2021 in TruvenHealth MarketScan Commercial Claims and Encounters Database, currently the largest US commercial insurance database. Patient selection using ICD-10 codes, data management, and statistical analyses were performed in Stata/SE18.0. Demographic, clinical, and financial attributes were summarized through descriptive statistics. IPCC measures were adjusted using 2023 Consumer Price Index Medical Care component. Primary study outcome was adjusted gross total payments (total IPCC). Given skewness in IPCC, log-transformation was carried out, followed by multivariable linear regression using socio-demographic, clinical and insurance-related characteristics to identify significant covariates. RESULTS A total of 1047 inpatient admissions across 1010 LMD patients were included. 43.8% (N=442) had brain metastases (BM) concomitantly present while 56.2% (N=568) did not. Primary tumor associated with LMD comprised of: lung and/or lower respiratory tract cancer (18%), breast cancer (6.6%), and melanoma (6.1%). 54.8% (N=554) did not have any bone metastases and 78.6% (N=794) did not have any liver metastases. Per inpatient admission, median adjusted values of gross total payments were $32603.6 (IQR $19967-64960) and gross payments to principal physician $1119.26 (IQR $532.41-2919.78), being 3.4% of total payments. Covariates associated with significantly higher total IPCC included age, male sex, length -of-stay, whole brain radiotherapy, and admission year, while cancer from lung and melanoma, medical and psychiatric admission (versus surgical), and drug claims capture were associated with significantly lower IPCC. CONCLUSIONS Contemporary IPCCs for LMD patients in US are substantial but driven minimally by payments to principal physician for services rendered.
INNV-32. LASER INTERSTITIAL THERMAL THERAPY FOLLOWED BY CONSOLIDATION STEREOTACTIC RADIOSURGERY (LITT-CSRS) IN PATIENTS WITH NEWLY DIAGNOSED BRAIN METASTASIS
Authors: Rajiv Dharnipragada, Rena Shah, Margaret Reynolds, Kathryn Dusenbery, Clark Chen
Journal: Neuro-Oncology (2024)

Abstract INTRODUCTION The efficacy and safety of laser interstitial thermal therapy followed by consolidation radiosurgery (LITT-cSRS) was previously studied in brain metastasis that recurs locally after initial radiosurgery (BMRS). Here, we characterize the clinical outcome of LITT-cSRS in patients with newly diagnosed brain metastasis. METHODS Between 2017 and 2023, ten consecutive cancer patients with newly diagnosed brain mass of unclear etiology who underwent stereotactic needle biopsy (SNB) and LITT in the same setting followed by consolidation SRS (cSRS) with &amp;gt; 6 months follow-up were identified retrospectively. Clinical and imaging outcomes were collected. RESULTS The histology of the BM were: breast cancer (n=3), melanoma (n=3), non-cell cell lung cancer (n=3), colon (n=1). There were no wound or procedural complications. All patients were discharged home, with a median one-day hospital stay (range: 1-2 days). All patients were off corticosteroid therapy by the one-month follow-up. cSRS were carried out 12-27 days (median of 19 days) after SNB+LITT. There were no subsequent emergency room presentation, 30-day or 90-day re-admission. The Karnofsky Performance Score (KPS) remains stable or improved at the 3 months-follow-up. With a median follow-up of 416 days (13.8 mo; range: 199-1,096 days), there was one local recurrence at 384 days (12.8 mo) post-LITT-cSRS. Of note, this is the only patient who underwent incomplete ablation with LITT and the location of the recurrence corresponded to the residual tumor that was not treated with LITT. With exception of this patient with local recurrence, all patients showed decreased FLAIR volume surrounding the LITT-cSRS treated BMRS by the six-month follow-up. CONCLUSIONS To our awareness, this case series represent the first to describe LITT-cSRS in the setting of newly diagnosed BM. The results presented here provide pilot data to support the safety and efficacy of LITT-cSRS and lay the foundation for future studies.
RADT-44. EARLY CLINICAL EXPERIENCE WITH PROTON CRANIOSPINAL IRRADIATION FOR THE TREATMENT OF LEPTOMENINGEAL DISEASE
Authors: Ariel E Marciscano, Felix Ehret, Ammy M Yuan, Stephen Zieminski, Peggy A Leland, Melin J Khandekar, Kevin S Oh, Helen A Shih
Journal: Neuro-Oncology (2024)

Abstract BACKGROUND Leptomeningeal disease (LMD) is a uniformly terminal event of advanced cancer with limited therapeutic options, with survival ranging from weeks to a few months. Recently, proton craniospinal irradiation (pCSI) has been demonstrated to confer a progression-free and overall survival benefit in select patients with LMD as compared to more limited site radiotherapy. Early results from an institutional experience of pCSI for patients with LMD from solid tumor malignancies are reviewed. METHODS All patients with LMD and treated with pCSI at our institution were reviewed, specifically with regards to baseline patient characteristics, radiation dosimetry parameters and clinical outcomes. RESULTS Between February 2023-April 2024, nine patients were treated with pCSI for a range of primary tumor histologies, including two with triple-negative breast cancer and one each with ER+/PR+/HER2- breast cancer, non-small cell lung cancer, small cell lung cancer, gastric cancer, esophageal cancer, pancreatic cancer and ovarian cancer. All patients received 30Gy(RBE) in 10 fractions to the craniospinal axis, with one patient receiving an intracranial boost (6Gy(RBE)). Median age and performance status was 58 years and KPS 80, respectively. Five (56%) patients underwent CSF diversion prior to pCSI, 22% of patients had undergone prior CNS-directed radiotherapy, and all patients received at least one line of systemic therapy in the metastatic setting prior to pCSI. Median survival from the first day of pCSI was 4.3 months (range 1.3-10.7mo). Median survival among patients undergoing CSF diversion prior to pCSI (n=5) was 5.3 months (vs. 2.9mo with no CSF diversion). Median survival among patients who received systemic treatment after pCSI (n=5) was 9.1 months (vs. 2.9mo for patients who did not). CONCLUSIONS Careful patient selection is imperative to identify those who will best benefit from pCSI with suggestion of patients undergoing pre-pCSI CSF diversion and receiving post-pCSI systemic therapy achieving superior survival.
BIOM-09. CLINICAL EFFECT OF CD25 ON THE MTX-BASED CHEMOSENSITIVITY OF PRIMARY CENTRAL NERVUS SYSTEM LYMPHOMA
Authors: Shunsuke Yamanishi, Hiroaki Nagashima, Kazuhiro Tanaka, Takashi Sasayama
Journal: Neuro-Oncology (2024)

Abstract INTRODUCTION Primary central nervous system diffuse large B-cell lymphoma (PCNSL) is treated with chemotherapy, mainly with high-dose methotrexate (HD-MTX), but some cases are resistant to treatment and relapse in a short period. However, a biomarker that predicts the chemosensitivity and recurrence has not yet been identified. In this study, we used surface marker analysis of tumor tissue using flow cytometry to search for biomarkers related to chemosensitivity and early recurrence. METHODS From 2017 to 2023, 25 patients were diagnosed with PCNSL by biopsy in Kobe University Hospital, and flow cytometry of the biopsy tissues were performed. Cerebrospinal fluid (CSF) examination including sIL2R, β2MG, and IL-10 was performed in all cases before surgery, and treatment based on methotrexate was administered postoperatively. We retrospectively analyzed patient characteristics, flow cytometry data, treatment details, response rate, time to recurrence, and overall survival. RESULTS The mean age of the patients was 71 (range, 37-80) years. In univariate analysis, high expression level of CD25 (interleukin-2 receptor, IL-2R) in the tissue was associated with a lower response rate to MTX-based chemotherapy (Fisher’s exact test, p=0.0072) and had a tendency of shorter time to recurrence. However, there were no significant differences in progression-free survival and overall survival. There was no correlation between expression level of CD25 in tissue and sIL-2R in CSF. Expression level of sIL-2R in CSF was independent of CD25 expression in tissue. CONCLUSION There are some reports that CD25 can be a prognostic factor in follicular lymphoma, but no reports in PCNSL. Here, we suggested that high expression level of CD25 in PCNSL tissue was associated to chemoresistance and early recurrence. In cases of PCNSL with high CD25 expression level, additional whole-brain irradiation and transition to tirabrutinib be considered because there are possibilities of chemoresistance and early recurrence.
CNSC-68. SEX DIFFERENCES IN GLYCINE BIOSYNTHESIS DRIVE RESPONSES TO COMBINED NUTRIENT DEPRIVATION AND PHARMACOLOGICAL INHIBITION IN PEDIATRIC HGG
Authors: Jianyun Lu, Camryn Marquez, Kevin Cho, Gary Patti, Joshua Rubin, Joseph Ippolito
Journal: Neuro-Oncology (2024)

Abstract In children and adults, high-grade gliomas (HGGs) are the most common and deadly primary brain malignancies. Generally, male HGGs occur at higher incidence and demonstrate more rapid proliferation, resulting in shorter overall male survival. Obscurity of molecular mechanisms driving this phenomenon prevents implementation of clinically effective treatments. Recently, a positive correlation between HGG cellular proliferation and metabolic reprogramming toward glycine biosynthesis was identified. By analyzing pediatric and adult HGG patient data, we discovered significantly worse outcomes unique to pediatric males bearing upregulation of serine and glycine biosynthesis transcripts. Previously, we have identified differential flux of glucose into serine and glycine biosynthesis drives sex differences in lung cancer. Therefore, we sought to confirm and target this paradigm in our NF1-/- DNp53 model of HGG. By performing metabolic tracing with [13C]-labeled glucose in male and female cells, we identified higher enrichment of [13C]-labeled serine and glycine in male cells relative to female cells. Through Western blotting, we identify male-specific upregulation of serine and glycine biosynthetic pathway enzymes in transformed cells, supporting our labelling results. Next, we sought to determine if inhibition of de-novo serine and glycine biosynthesis was similarly sex-biased. Utilizing serine-and-glycine-deprived media conditions, we identified a male-biased decrease in proliferation following pharmacological inhibition of de-novo serine and glycine biosynthesis. More precisely, in the absence of exogenous glycine, we discovered that inhibition of de-novo synthesis of glycine from serine drove male-specific decreases in proliferation. Additionally, we identified that transformed female cell robustness against inhibition of glycine biosynthesis is driven by the uptake of exogenous nucleotide precursors. These data confirm that sex differences in de-novo glycine biosynthesis drive sex differences in HGG cellular proliferation. As well, our work suggests that dietary restriction of serine and glycine, in-combination with pharmacological inhibition of de-novo glycine biosynthesis, represents a novel treatment paradigm.
EPCO-08. EPIGENETIC THERAPY POTENTIATES TRANSPOSABLE ELEMENT TRANSCRIPTION TO CREATE TUMOR-ENRICHED ANTIGENS IN GLIOBLASTOMA
Authors: H Josh Jang, Nakul M Shah, Ju Heon Maeng, Yonghao Liang, Noah L Basri, Jiaxin Ge, Xuan Qu, Tatenda Mahlokozera, Shin-Cheng Tzeng, Russell B Williams, Michael J Moore, Devi Annamalai, Justin Y Chen, Hyung Joo Lee, Patrick A DeSouza, Daofeng Li, Xiaoyun Xing, Albert H Kim, Ting Wang
Journal: Neuro-Oncology (2024)

Abstract Epigenetic treatment has been studied as a means to augment anti-tumor immune cell activity by increasing the expression of antiviral response genes. Previous studies, including our own, have revealed an additional consequence of epigenetic treatment: reactivation of transposable elements (TEs). Normally, most TEs are epigenetically repressed in healthy somatic tissues. However, epigenetic treatment can reactivate TEs as previously unannotated promoters, particularly in rapidly proliferating cells. These reactivated TEs could generate unique proteins that may act as novel antigens for immunotherapy. To study epigenetic treatment as a novel method to augment immunotherapy in cancers with a low number of somatic mutation-derived antigens, we chose glioblastoma as a model. Specifically, we investigated if drug-induced TE expression increases the antigen repertoire upon combinatorial treatment with DNMT inhibitor (Decitabine) and HDAC inhibitor (Panobinostat), agents currently being tested for clinical use in cancers, including CNS tumors. Using patient-derived primary glioblastoma stem cell (GSC) lines and control cell lines (astrocytes and fibroblasts), we first profiled treatment-induced changes in the epigenetic landscape using WGBS-seq and ATAC-seq. Then, using nanoCAGE-seq, both short-read and long-read RNA-seq, we identified treatment-induced, TE-derived transcripts that are predominantly expressed in glioblastoma cells along with upregulation of antiviral gene programs. Finally, using LC-MS/MS, we validated that tumor-enriched reactivated TEs, which mostly originate from the LTR class, encode HLA-I presented antigens in primary GSCs. Notably, epigenetic therapy also reactivated many TEs in proliferating control cell lines, and thus we provide evidence that targeted approaches like CRISPRa might reduce the side effects of activating nonspecific TE loci. Overall, our findings suggest that the therapeutic utilization of epigenetic treatment-induced, TE-derived antigens holds great promise but also provides a cautionary tale regarding the careful selection of tumor-enriched antigen targets.
INNV-18. FOCUS ON CURRENT AND EMERGING TREATMENT OPTIONS FOR GLIOMA: A COMPREHENSIVE REVIEW
Authors: Brandon Lucke-Wold, Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Abdul Haseeb
Journal: Neuro-Oncology (2024)

Abstract This comprehensive review delves into the current updates and challenges associated with the management of low-grade gliomas (LGG), the predominant primary tumors in the central nervous system. With a general incidence rate of 5.81 per 100000, gliomas pose a significant global concern, necessitating advancements in treatment techniques to reduce mortality and morbidity. This review places a particular focus on immunotherapies, discussing promising agents such as Zotiraciclib and Lerapolturev. Zotiraciclib, a CDK9 inhibitor, has demonstrated efficacy in glioblastoma treatment in preclinical and clinical studies, showing its potential as a therapeutic breakthrough. Lerapolturev, a viral immunotherapy, induces inflammation in glioblastoma and displays positive outcomes in both adult and pediatric patients. Exploration of immunotherapy extends to Pembrolizumab, Nivolumab, and Entrectinib, revealing the challenges and variabilities in patient responses. Despite promising preclinical data, the monoclonal antibody Depatuxizumab has proven ineffective in glioblastoma treatment, emphasizing the critical need to understand resistance mechanisms. The review also covers the success of radiation therapy in pediatric LGG, with evolving techniques, such as proton therapy, showing potential improvements in patient quality of life. Surgical treatment is discussed in the context of achieving a balance between preserving the patient’s quality of life and attaining gross total resection, with the extent of surgical resection significantly influencing the survival outcomes. In addition to advancements in cancer vaccine development, this review highlights the evolving landscape of LGG treatment, emphasizing a shift toward personalized and targeted therapies. Ongoing research is essential for refining strategies and enhancing outcomes in the management of LGG.