EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

Nature Reviews Clinical Oncology, Journal Year: 2020, Volume and Issue: 18(3), P. 170 - 186

Published: Dec. 8, 2020

Abstract In response to major changes in diagnostic algorithms and the publication of mature results from various large clinical trials, European Association Neuro-Oncology (EANO) recognized need provide updated guidelines for diagnosis management adult patients with diffuse gliomas. Through these evidence-based guidelines, a task force EANO provides recommendations diagnosis, treatment follow-up The component is based on 2016 update WHO Classification Tumors Central Nervous System subsequent Consortium Inform Molecular Practical Approaches CNS Tumour Taxonomy — Not Officially (cIMPACT-NOW). With regard therapy, we formulated latest practice-changing trials also guidance neuropathological neuroradiological assessment. define role modalities surgery, radiotherapy systemic pharmacotherapy, covering current advances cognizant that unnecessary interventions expenses should be avoided. This document intended source reference professionals involved gliomas, caregivers, health-care providers.

Language: Английский

---

Network pharmacology: curing causal mechanisms instead of treating symptoms

Trends in Pharmacological Sciences, Journal Year: 2021, Volume and Issue: 43(2), P. 136 - 150

Published: Dec. 9, 2021

Language: Английский

---

Glioblastoma and Other Primary Brain Malignancies in Adults

JAMA, Journal Year: 2023, Volume and Issue: 329(7), P. 574 - 574

Published: Feb. 21, 2023

Importance Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of malignant is approximately 7 100 individuals and increases with age. Five-year survival 36%. Observations Approximately 49% are glioblastomas, 30% diffusely infiltrating lower-grade gliomas. Other include central nervous system (CNS) lymphoma (7%) forms ependymomas (3%) meningiomas (2%). Symptoms headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), focal neurologic deficits (10%-40%). Magnetic resonance imaging before after a gadolinium-based contrast agent preferred modality for evaluating tumors. Diagnosis requires tumor biopsy consideration histopathological molecular characteristics. Treatment varies by type often includes combination surgery, chemotherapy, radiation. For patients glioblastoma, temozolomide radiotherapy improved when compared alone (2-year survival, 27.2% vs 10.9%; 5-year 9.8% 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In anaplastic oligodendroglial 1p/19q codeletion, probable 20-year overall following without procarbazine, lomustine, vincristine was 13.6% 37.1% (80 patients; HR, 0.60 0.35-1.03]; = .06) EORTC 26951 trial 14.9% 37% RTOG 9402 (125 0.61 0.40-0.94]; .02). CNS high-dose methotrexate-containing regimens, followed consolidation therapy myeloablative chemotherapy autologous stem cell rescue, nonmyeloablative or whole Conclusions Relevance individuals, glioblastomas. Most die from progressive disease. First-line glioblastoma surgery radiation alkylating chemotherapeutic temozolomide.

Language: Английский

---

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Journal of the National Comprehensive Cancer Network, Journal Year: 2020, Volume and Issue: 18(11), P. 1537 - 1570

Published: Nov. 1, 2020

The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. involvement an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, neuroradiologists, is a key factor in the appropriate cancers. Integrated histopathologic molecular characterization tumors such as gliomas should be standard practice. This article describes recommendations WHO grade I, II, III, IV gliomas. Treatment metastases, most common intracranial adults, also described.

Language: Английский

---

Interactions between cancer cells and immune cells drive transitions to mesenchymal-like states in glioblastoma

Cancer Cell, Journal Year: 2021, Volume and Issue: 39(6), P. 779 - 792.e11

Published: June 1, 2021

Language: Английский

---

Phase III trial of chemoradiotherapy with temozolomide plus nivolumab or placebo for newly diagnosed glioblastoma with methylated MGMT promoter

Neuro-Oncology, Journal Year: 2022, Volume and Issue: 24(11), P. 1935 - 1949

Published: April 28, 2022

Abstract Background Nearly all patients with newly diagnosed glioblastoma experience recurrence following standard-of-care radiotherapy (RT) + temozolomide (TMZ). The purpose of the phase III randomized CheckMate 548 study was to evaluate RT TMZ combined immune checkpoint inhibitor nivolumab (NIVO) or placebo (PBO) in methylated MGMT promoter (NCT02667587). Methods Patients (N = 716) were 1:1 NIVO [(240 mg every 2 weeks × 8, then 480 4 weeks) (60 Gy over 6 (75 mg/m2 once daily during RT, 150-200 on days 1-5 28-day cycle 6)] PBO same regimen. primary endpoints progression-free survival (PFS) and overall (OS) without baseline corticosteroids patients. Results As December 22, 2020, median (m)PFS (blinded independent central review) 10.6 months (95% CI, 8.9-11.8) vs 10.3 9.7-12.5) (HR, 1.1; 95% 0.9-1.3) mOS 28.9 24.4-31.6) 32.1 29.4-33.8), respectively 0.9-1.3). In corticosteroids, 31.3 28.6-34.8) 33.0 31.0-35.1) 0.9-1.4). Grade 3/4 treatment-related adverse event rates 52.4% 33.6%, respectively. Conclusions added did not improve indeterminate promoter. No new safety signals observed.

Language: Английский

---

Glioma progression is shaped by genetic evolution and microenvironment interactions

Cell, Journal Year: 2022, Volume and Issue: 185(12), P. 2184 - 2199.e16

Published: May 31, 2022

Language: Английский

---

Radiotherapy combined with nivolumab or temozolomide for newly diagnosed glioblastoma with unmethylated MGMT promoter: An international randomized phase III trial

Neuro-Oncology, Journal Year: 2022, Volume and Issue: 25(1), P. 123 - 134

Published: April 14, 2022

Addition of temozolomide (TMZ) to radiotherapy (RT) improves overall survival (OS) in patients with glioblastoma (GBM), but previous studies suggest that tumors harboring an unmethylated MGMT promoter derive minimal benefit. The aim this open-label, phase III CheckMate 498 study was evaluate the efficacy nivolumab (NIVO) + RT compared TMZ newly diagnosed GBM promoter.Patients were randomized 1:1 standard (60 Gy) NIVO (240 mg every 2 weeks for eight cycles, then 480 4 weeks) or (75 mg/m2 daily during and 150-200 mg/m2/day 5/28 days maintenance). primary endpoint OS.A total 560 randomized, 280 each arm. Median OS (mOS) 13.4 months (95% CI, 12.6 14.3) 14.9 13.3 16.1) (hazard ratio [HR], 1.31; 95% 1.09 1.58; P = .0037). progression-free 6.0 5.7 6.2) 6.2 5.9 6.7) (HR, 1.38; 1.15 1.65). Response rates 7.8% (9/116) 7.2% (8/111) RT; grade 3/4 treatment-related adverse event (TRAE) 21.9% 25.1%, any-grade serious TRAE 17.3% 7.6%, respectively.The did not meet improved OS; demonstrated a longer mOS than RT. No new safety signals detected study. difference between treatment arms is consistent use as care GBM.ClinicalTrials.gov NCT02617589.

Language: Английский

---

Single-cell analysis of human glioma and immune cells identifies S100A4 as an immunotherapy target

Nature Communications, Journal Year: 2022, Volume and Issue: 13(1)

Published: Feb. 9, 2022

Abstract A major rate-limiting step in developing more effective immunotherapies for GBM is our inadequate understanding of the cellular complexity and molecular heterogeneity immune infiltrates gliomas. Here, we report an integrated analysis 201,986 human glioma, immune, other stromal cells at single cell level. In doing so, discover extensive spatial infiltrates. We identify signatures nine distinct myeloid subtypes, which five are independent prognostic indicators glioma patient survival. Furthermore, S100A4 as a regulator suppressive T demonstrate that deleting S100a4 non-cancer sufficient to reprogram landscape significantly improve This study provides insights into spatial, molecular, functional glioma-associated demonstrates utility this dataset discovering therapeutic targets poorly immunogenic cancer.

Language: Английский

---

Glioblastoma: clinical presentation, diagnosis, and management

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n1560 - n1560

Published: July 14, 2021

What you need to know1. Early symptoms of brain tumours in adults are non-specific and patients may present multiple times primary care services before they referred for investigation.Look out raised intracranial pressure (e.g.headaches exacerbated by lying down, triggered Valsalva maneuver or associated with vomiting visual disturbance), combinations (e.g.headache plus cognitive impairment, headache weakness, personality change) which progress over time.New-onset focal generalized seizures adulthood also warrant investigation a tumour.2. In signs suggestive tumour, arrange an urgent MRI head without contrast through rapid-access 'suspected cancer' pathway, when available.In suspicion pressure, same-day clinical assessment contrast-enhanced CT scan.3. Glioblastoma (GBM) is the most common cancer.Standard treatment includes maximal safe resection followed concomitant radiotherapy temozolomide (TMZ) chemotherapy then adjuvant TMZ.Disease progression expected all cases consideration further should take into account patient's performance status, tumour size, location time since first 4. Key supportive medications include corticosteroids vasogenic oedema anti-epileptic medication if occur 5. Due incurable rapidly progressive nature glioblastoma, close collaboration between multidisciplinary teams tertiary hospitals recommended.Early involvement GPs specialist community palliative can assist caregivers advance planning as well management symptoms, physical communication difficulties innate uncertainties about disease progression.

Language: Английский

---