CNS OncologyPub Date : 2019-06-20DOI: 10.2217/cns-2019-0010
Ugur T Sener, Nassim Matin, H. Yu, A. Lin, T. Yang, R. Malani
{"title":"Radiographic appearance of leptomeningeal disease in patients with EGFR-mutated non-small-cell lung carcinoma treated with tyrosine kinase inhibitors: a case series","authors":"Ugur T Sener, Nassim Matin, H. Yu, A. Lin, T. Yang, R. Malani","doi":"10.2217/cns-2019-0010","DOIUrl":"https://doi.org/10.2217/cns-2019-0010","url":null,"abstract":"EGFR is frequently mutated in non-small-cell lung carcinomas (NSCLCs). Clinically available tyrosine kinase inhibitors (TKIs) are effective in treating EGFR-mutant NSCLC. In this case series, we present five patients with TKI-treated EGFR-mutated NSCLC who developed leptomeningeal disease (LMD) lacking characteristic imaging findings. All five patients received TKIs prior to development of cytology-confirmed LMD. Clinical signs of LMD preceded radiographic evidence by 2–12 months. T790M, the most common resistance mutation to first-generation EGFR inhibitors, was identified in four cases. These cases illustrate that in patients with EGFR-mutant NSCLC, TKIs may effectively control LMD, creating a lag between onset of symptoms and observation of radiographic findings.","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89427591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-06-01Epub Date: 2019-03-11DOI: 10.2217/cns-2018-0015
David E Piccioni, Achal Singh Achrol, Lesli A Kiedrowski, Kimberly C Banks, Najee Boucher, Garni Barkhoudarian, Daniel F Kelly, Tiffany Juarez, Richard B Lanman, Victoria M Raymond, Minhdan Nguyen, Judy D Truong, Annie Heng, Jaya Gill, Marlon Saria, Sandeep C Pingle, Santosh Kesari
{"title":"Analysis of cell-free circulating tumor DNA in 419 patients with glioblastoma and other primary brain tumors.","authors":"David E Piccioni, Achal Singh Achrol, Lesli A Kiedrowski, Kimberly C Banks, Najee Boucher, Garni Barkhoudarian, Daniel F Kelly, Tiffany Juarez, Richard B Lanman, Victoria M Raymond, Minhdan Nguyen, Judy D Truong, Annie Heng, Jaya Gill, Marlon Saria, Sandeep C Pingle, Santosh Kesari","doi":"10.2217/cns-2018-0015","DOIUrl":"https://doi.org/10.2217/cns-2018-0015","url":null,"abstract":"<p><p><b>Aim:</b> Genomically matched trials in primary brain tumors (PBTs) require recent tumor sequencing. We evaluated whether circulating tumor DNA (ctDNA) could facilitate genomic interrogation in these patients. <b>Methods:</b> Data from 419 PBT patients tested clinically with a ctDNA NGS panel at a CLIA-certified laboratory were analyzed. <b>Results:</b> A total of 211 patients (50%) had ≥1 somatic alteration detected. Detection was highest in meningioma (59%) and gliobastoma (55%). Single nucleotide variants were detected in 61 genes, with amplifications detected in <i>ERBB2, MET, EGFR</i> and others. <b>Conclusion:</b> Contrary to previous studies with very low yields, we found half of PBT patients had detectable ctDNA with genomically targetable off-label or clinical trial options for almost 50%. For those PBT patients with detectable ctDNA, plasma cfDNA genomic analysis is a clinically viable option for identifying genomically driven therapy options.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37042504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-06-01Epub Date: 2019-03-11DOI: 10.2217/cns-2018-0018
Maya Harary, David A Reardon, J Bryan Iorgulescu
{"title":"Efficacy and safety of immune checkpoint blockade for brain metastases.","authors":"Maya Harary, David A Reardon, J Bryan Iorgulescu","doi":"10.2217/cns-2018-0018","DOIUrl":"https://doi.org/10.2217/cns-2018-0018","url":null,"abstract":"hepatocellular carcinoma,","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37042597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-06-01Epub Date: 2019-07-11DOI: 10.2217/cns-2019-0007
Liang Yen Liu, Matthew S Ji, Nhung T Nguyen, Frances E Chow, Donna M Molaie, Sean T Pianka, Richard M Green, Linda M Liau, Benjamin M Ellingson, Phioanh L Nghiemphu, Timothy F Cloughesy, Albert Lai
{"title":"Patterns of long-term survivorship following bevacizumab treatment for recurrent glioma: a case series.","authors":"Liang Yen Liu, Matthew S Ji, Nhung T Nguyen, Frances E Chow, Donna M Molaie, Sean T Pianka, Richard M Green, Linda M Liau, Benjamin M Ellingson, Phioanh L Nghiemphu, Timothy F Cloughesy, Albert Lai","doi":"10.2217/cns-2019-0007","DOIUrl":"https://doi.org/10.2217/cns-2019-0007","url":null,"abstract":"<p><p><b>Aim:</b> Long-term survivors (LTS) after glioma recurrence while on bevacizumab (Bev) therapy are rarely reported in the current literature. The purpose of this case series is to confirm the existence of and describe a large cohort of recurrent glioma LTS treated with Bev (Bev-LTS). <b>Patients & methods:</b> We identified Bev-LTS as patients with post-Bev initiation survival times of ≥3 years among 1397 Bev treated recurrent glioma patients. <b>Results:</b> Among 962 grade-IV, 221 grade III, and 214 grade II Bev-treated glioma patients, we identified 28 (2.9%), 14 (6.3%) and 8 (3.7%) Bev-LTS patients, respectively. 45 Bev-LTS patients recurred on Bev, with 36 of those patients continuing therapy. <b>Conclusion:</b> Our study shows that a small portion of grade-IV, -III, and -II glioma patients can have long-term survival on Bev therapy even after Bev recurrence.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2019-0007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37406325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-06-01Epub Date: 2019-07-10DOI: 10.2217/cns-2019-0004
Raffaele Addeo, Giuseppe Lamberti, Giorgia Simonetti, Patrizia Iodice, Alfredo Marinelli, Liliana Montella, Salvatore Cappabianca, Paola Gaviani, Michele Caraglia, Salvatore Del Prete, Antonio Silvani
{"title":"Biweekly fotemustine schedule for recurrent glioblastoma in the elderly: activity and toxicity assessment of a multicenter study.","authors":"Raffaele Addeo, Giuseppe Lamberti, Giorgia Simonetti, Patrizia Iodice, Alfredo Marinelli, Liliana Montella, Salvatore Cappabianca, Paola Gaviani, Michele Caraglia, Salvatore Del Prete, Antonio Silvani","doi":"10.2217/cns-2019-0004","DOIUrl":"10.2217/cns-2019-0004","url":null,"abstract":"<p><p><b>Aim:</b> To assess the efficacy and safety of alternative fotemustine administration schedule in elderly patients with recurrent glioblastoma. <b>Patients & methods:</b> Patients aged >65 years with recurrent glioblastoma received fotemustine (80 mg/m<sup>2</sup>; days 1, 15, 30, 45 and 60, and subsequently every 4 weeks). Primary end point was progression-free survival (PFS) rate at 6 months. Main secondary end point was safety. <b>Results:</b> 58 patients were enrolled at two centers. PFS at 6 months was 47% (27 patients) and overall response rate was 29%. Median PFS and survival were 6 and 7 months, respectively, and longer in responders versus nonresponders. No grade 3-4 hematological toxicities occurred. <b>Conclusion:</b> The alternative fotemustine administration schedule was an effective and safe treatment for recurrent glioblastoma in elderly patients.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2019-0004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37409139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-06-01Epub Date: 2019-07-10DOI: 10.2217/cns-2019-0003
Samia Asif, Rawish Fatima, Rebecca Krc, Joseph Bennett, Shahzad Raza
{"title":"Comparative proteogenomic characterization of glioblastoma.","authors":"Samia Asif, Rawish Fatima, Rebecca Krc, Joseph Bennett, Shahzad Raza","doi":"10.2217/cns-2019-0003","DOIUrl":"10.2217/cns-2019-0003","url":null,"abstract":"<p><p><b>Aim:</b> Glioblastoma multiforme (GBM) carries a dismal prognosis. Integrated proteogenomic analysis was performed to understand GBM pathophysiology. <b>Patients & methods:</b> 17 patient samples were analyzed for driver mutations, oncogenes, major pathway alterations and molecular changes at gene and protein level. Clinical, treatment and survival data were collected. <b>Results:</b> Significantly mutated genes included <i>TP53</i>, <i>EGFR</i>, <i>PIK3R1</i>, <i>PTEN</i>, <i>NF1</i>, <i>RET</i> and <i>STAG2</i>. EGFR mutations noted included EGFRvIII-expression, EGFR-<i>L816Q</i> missense mutation-exon 21 and EGFR fusion (FGFR3-TACC3). <i>TP53</i> mutations were noticed in COSMIC hot-spot driver gene and accompany <i>IDH1</i> and <i>ATRX</i> mutations suggesting low- to high-grade glioma transformation. Proteomics showed higher (53%) EGFR expression than genomic expression (23%). MGMT methylation was present in two-thirds of cases. <b>Conclusion:</b> This study identifies a distinct biological process that may characterize each GBM differently. Proteogenomic data identify potential therapeutic targets of GBM.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/6e/cns-08-37.PMC6713026.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37404356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-03-01Epub Date: 2019-01-31DOI: 10.2217/cns-2018-0016
Ashwin Shinde, David Akhavan, Mina Sedrak, Scott Glaser, Arya Amini
{"title":"Shifting paradigms: whole brain radiation therapy versus stereotactic radiosurgery for brain metastases.","authors":"Ashwin Shinde, David Akhavan, Mina Sedrak, Scott Glaser, Arya Amini","doi":"10.2217/cns-2018-0016","DOIUrl":"https://doi.org/10.2217/cns-2018-0016","url":null,"abstract":"Management of intracranial metastases with radiation has historically been performed with whole brain radiation therapy (WBRT), which encompasses the entire brain, treating both visible and potentially microscopic disease [1]. In 1961, a Swedish neurosurgeon, Lars Leksell introduced the concept of stereotactic radiosurgery (SRS), in which a high dose of radiation could be delivered to a solitary lesion in a single treatment [2]. The concept of SRS, which has since become standard practice at many institutions, is to deliver higher dose per treatment for better disease control with minimal effect on normal brain tissue, leading ultimately to improved cognitive outcomes. This article will evaluate the shift in intracranial radiation from WBRT to SRS.","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36914049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-03-01Epub Date: 2018-12-14DOI: 10.2217/cns-2018-0013
Charles Cobbs, Edward McClay, J Paul Duic, L Burt Nabors, Donna Morgan Murray, Santosh Kesari
{"title":"An early feasibility study of the Nativis Voyager<sup>®</sup> device in patients with recurrent glioblastoma: first cohort in US.","authors":"Charles Cobbs, Edward McClay, J Paul Duic, L Burt Nabors, Donna Morgan Murray, Santosh Kesari","doi":"10.2217/cns-2018-0013","DOIUrl":"https://doi.org/10.2217/cns-2018-0013","url":null,"abstract":"<p><strong>Aim: </strong>Evaluation of the Nativis Voyager<sup>®</sup> device in patients with recurrent glioblastoma (rGBM).</p><p><strong>Materials & methods: </strong>Voyager is a noninvasive, nonthermal, nonionizing and portable investigational device which delivers ultra-low radio frequency energy (ulRFE<sup>®</sup>) that uses a magnetic field to penetrate tissues to alter specific biologic functions within cells. Patients with rGBM were treated with Voyager alone (V) or Voyager in combination with standard of care (V + SoC). Safety and clinical utility were assessed every 2-4 months.</p><p><strong>Results: </strong>Data from the first 11 patients treated are reported here. Median progression-free survival was 10 weeks in the V arm and 16 weeks in the V + SoC arm. Median overall survival was 16 months in V arm and 11 months in the V + SoC arm. No serious adverse events associated with the device were reported.</p><p><strong>Conclusion: </strong>These data suggest that the Voyager is safe and feasible for the treatment of rGBM.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36782179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-03-01Epub Date: 2019-02-28DOI: 10.2217/cns-2018-0012
Sagar Bhalerao, Rajnish Nagarkar, Aditya Adhav
{"title":"A case report of high-grade astroblastoma in a young adult.","authors":"Sagar Bhalerao, Rajnish Nagarkar, Aditya Adhav","doi":"10.2217/cns-2018-0012","DOIUrl":"https://doi.org/10.2217/cns-2018-0012","url":null,"abstract":"<p><p>Astroblastoma is an uncommon neuroepithelial primary tumor of the brain which is of uncertain origin. We present a case of high-grade astroblastoma in an 18-year-old female with a severe headache, loss of appetite, vomiting and generalized weakness. The patient had undergone a right frontoparietal craniotomy. Large subfalcine meningioma was excised. The lesion was suspected to be a meningioma. Primary radiological investigation revealed a 6.8 cm × 5.8 cm × 5.4 cm lesion. Although the radiological and intraoperative findings were of an extra-axial tumor, the histology and immunophenotype was of an astroblastoma. The patient was treated with cyclophosphamide, cisplatin and etoposide chemotherapy regimen. The patient was later treated with bi-weekly bevacizumab. The patient had improved symptomatically post-chemotherapy. However, there was no significant difference in lesion size. The patient died after 2 weeks. The prognosis of patients with astroblastoma is extremely poor as observed in our case.</p>","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37006672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CNS OncologyPub Date : 2019-03-01Epub Date: 2019-02-15DOI: 10.2217/cns-2018-0019
Victor A Levin
{"title":"How far will the Voyager<sup>®</sup> take us?","authors":"Victor A Levin","doi":"10.2217/cns-2018-0019","DOIUrl":"https://doi.org/10.2217/cns-2018-0019","url":null,"abstract":"Need for better treatments for glioblastoma Overall survival of people afflicted with glioblastoma (GBM) has improved modestly over the past 30 years and ranges between a median overall survival of 10 and 16 months depending on factors such as age, gender, extent of surgery, molecular-genetic features of resected tumors, radiation therapy and chemotherapy. Treatment options for people afflicted with GBM have changed somewhat based on molecular-genetic profiles that define worst-case scenarios [1–3] and improvements in radiation therapy that have also reduced CNS toxicity somewhat [4]. Based on patient convenience and outcomes, temozolomide has become the major anticancer drug therapy for these tumors [5]. Most recently, chronic treatment with alternating electric tumor treating fields to the head has gained US FDA approval for the treatment of GBM [6,7]. New therapies, especially new chemotherapy drugs, have been limited to brain penetrant alkylating agents (i.e., carmustine, lomustine, and temozolomide) since the 1970s. There are several reasons for this, which relate to drug delivery to infiltrative tumor cells behind the blood–brain barrier (BBB), drug residence time on tumor cell target, appropriateness of cellular target and the need to inhibit more than one cellular target, drug pharmacokinetics and drug safety [8,9].","PeriodicalId":10469,"journal":{"name":"CNS Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cns-2018-0019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36561995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}