October 21, 2015—San Antonio, Texas—BRCA1 protein expression was an important predictive factor in a cohort of patients with glioblastoma multiforme.
Maria Vassilakopoulou, MD, PhD, of Pitié-Salpêtrière Hospital, Paris, explained that glioblastoma multiforme is the most common malignant brain tumor, and the median survival in patients with the tumor is <1 year in the pre-temozolomide era.( chemotherapy)
Histologic parameters ( what it looks like under the microscope after the first stpe which is trying to remove it all , are of limited value in predicting survival among patients with glioblastoma multiforme. No prognostic or predictive biomarkers have been translated into routine clinical use.
For the 56 patients with sufficient tumor for testing, patients with BRCA1 protein expressions below median ( the middle amount ) survived a median of 18.9 vs. 4.8 months for those with higher expressions.
Dr. Vassilakopoulou concluded that BRCA1 protein expression was an important predictive factor in this cohort of glioblastoma multiforme patients.
This result implies that low BRCA1 in the tumor, and the consequent low level of DNA repair, may increase glioblastoma multiforme vulnerability to treatment. Prospective validation of these results is necessary.
2. Overall Survival Appears Worse in Patients with Symptomatic Recurrence of Glioblastoma Multiforme
October 21, 2015—San Antonio, Texas—Overall survival appears to be worse in patients with glioblastoma multiforme who present with symptoms at the time of recurrence. This conclusion, drawn from results of a retrospective study, was presented at the 57th Annual Meeting of the American Society for Radiation Oncology, from October 18 – 21. Basel Mohammad Altoos, BS, of the University of Colorado, Aurora, explained that glioblastoma multiforme is a nearly uniformly fatal brain tumor with a median recurrence at 8 months and survival of 14 months after multimodality treatment. Median time to recurrence was 9.5 (range 3 – 49) months. Forty relapses (66.7%) were symptomatic, and 20 (33.3%) were radiographic.( seen on MRI or other imaging study before the patient had symptoms. Median overall survival for the symptomatic and radiographic cohorts were 15.5 and 20 months, respectively, a relative difference of 4.5 months (P = .090). living longer if the recurrence was found on imaging but the patient felt fine. Postrelapse survival was 3 months in patients who recurred symptomatically and 10 months for those whose disease recurrence was noted on imaging only (P = .005). If this difference is confirmed, future studies evaluating treatment options in the recurrent setting may need to stratify patients based on the presence of symptoms at the time of enrollment.
3. Local Failure Continues to Prevail as the Predominant Mode of Failure Following Reirradiation for Recurrent High-Grade Glioma
October 21, 2015—San Antonio, Texas—The predominant mode of failure following repeat radiation for high-grade glioma continues to be local 70-90% of the time
Treatment of recurrence varies, but one option is repeat radiotherapy. Dr. Palmer and colleagues reported patterns of recurrence following repeat radiation with fractionated stereotactic radiotherapy for recurrent high-grade glioma. ( so called gamma kife) Median an survival from fractionated stereotactic radiotherapy was 10.8 months. Eighty-six percent of subsequent recurrences after fractionated stereotactic radiotherapy were within the reirradiated field. Of the remaining 14% of recurrences, eight were marginal and seven were out of field.
Dr. Palmer concluded that the predominant mode of failure following repeat radiation for high-grade glioma continues to be local. Patients with transformed or recurrent anaplastic glioma, however, were at increased risk of marginal/distant recurrence.Based on Dr. Palmer’s experience, recurrences with proximity to the ventricular system are at risk for distant spread. The results serve to generate hypotheses. Further study is warranted.”Unexpectedly, we found that transformed and anaplastic gliomas failed distantly more commonly than glioblastoma,” Dr. Palmer said.“Furthermore, distant failures were common if the initial recurrence abutted the ventricular system,” he added. “Future directions in our group will be to determine whether these ventricular failures may benefit from the addition of chemotherapy/targeted therapy, and to further define a subgroup that may benefit from a larger treatment volume.”
4. Concurrent Chemoradiation Is Associated with Longer Survival than Radiotherapy Alone for Anaplastic Gliomas October 20, 2015—San Antonio, Texas—Patients receiving concurrent chemoradiation for anaplastic gliomas appear to experience significantly improved outcomes vs upfront radiation alone. Debra Nana Yeboa, MD, of Yale University, New Haven, Connecticut, explained that the role of concurrent chemoradiation therapy is under investigation for anaplastic gliomas. The group examined the adoption of concurrent chemoradiation therapy for grade 3 gliomas and compared outcomes to upfront radiation therapy alone. In terms of survival follow-up data, patients receiving concurrent chemoradiation vs radiotherapy alone experienced significantly improved overall survival (median 4.6 vs 3.3 years; Receipt of concurrent chemoradiation vs radiotherapy alone was significantly associated with lower risk of death as were diagnosis at an academic center
Information on molecular prognostic markers present in the tumor tissue is needed through current randomized trials. Further research is needed to improve disparities in treatment selection based on sociodemographic factors such as gender and insurance status.