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An expanded safety/feasibility study of the EMulate Therapeutics Voyager™ System in patients with recurrent glioblastoma

Barkhoudarian, Garni; Badruddoja, Michael; Blondin, Nicholas; Chowdhary, Sajeel; Cobbs, Charles; Duic, Julius Paul; Flores, John Paul; Fonkem, Ekokobe; McClay, Edward; Nabors, Louis Burt; Salacz, Michael; Taylor, Lynn; Vaillant, Brian; Gill, Jaya; Kesari, Santosh
PMID: 37462385
ISSN: 2045-0915
CID: 5535612

Corrigendum: Time interval from diagnosis to treatment of brain metastases with stereotactic radiosurgery is not associated with radionecrosis or local failure

Leu, Justin; Akerman, Meredith; Mendez, Christopher; Lischalk, Jonathan W; Carpenter, Todd; Ebling, David; Haas, Jonathan A; Witten, Matthew; Barbaro, Marissa; Duic, Paul; Tessler, Lee; Repka, Michael C
[This corrects the article DOI: 10.3389/fonc.2023.1132777.].
PMID: 37093946
ISSN: 2234-943x
CID: 5465052

Time interval from diagnosis to treatment of brain metastases with stereotactic radiosurgery is not associated with radionecrosis or local failure

Leu, Justin; Akerman, Meredith; Mendez, Christopher; Lischalk, Jonathan W; Carpenter, Todd; Ebling, David; Haas, Jonathan A; Witten, Matthew; Barbaro, Marissa; Duic, Paul; Tessler, Lee; Repka, Michael C
INTRODUCTION/UNASSIGNED:Brain metastases are the most common intracranial tumor diagnosed in adults. In patients treated with stereotactic radiosurgery, the incidence of post-treatment radionecrosis appears to be rising, which has been attributed to improved patient survival as well as novel systemic treatments. The impacts of concomitant immunotherapy and the interval between diagnosis and treatment on patient outcomes are unclear. METHODS/UNASSIGNED:This single institution, retrospective study consisted of patients who received single or multi-fraction stereotactic radiosurgery for intact brain metastases. Exclusion criteria included neurosurgical resection prior to treatment and treatment of non-malignant histologies or primary central nervous system malignancies. A univariate screen was implemented to determine which factors were associated with radionecrosis. The chi-square test or Fisher's exact test was used to compare the two groups for categorical variables, and the two-sample t-test or Mann-Whitney test was used for continuous data. Those factors that appeared to be associated with radionecrosis on univariate analyses were included in a multivariable model. Univariable and multivariable Cox proportional hazards models were used to assess potential predictors of time to local failure and time to regional failure. RESULTS/UNASSIGNED:A total of 107 evaluable patients with a total of 256 individual brain metastases were identified. The majority of metastases were non-small cell lung cancer (58.98%), followed by breast cancer (16.02%). Multivariable analyses demonstrated increased risk of radionecrosis with increasing MRI maximum axial dimension (OR 1.10, p=0.0123) and a history of previous whole brain radiation therapy (OR 3.48, p=0.0243). Receipt of stereotactic radiosurgery with concurrent immunotherapy was associated with a decreased risk of local failure (HR 0.31, p=0.0159). Time interval between diagnostic MRI and first treatment, time interval between CT simulation and first treatment, and concurrent immunotherapy had no impact on incidence of radionecrosis or regional failure. DISCUSSION/UNASSIGNED:An optimal time interval between diagnosis and treatment for intact brain metastases that minimizes radionecrosis and maximizes local and regional control could not be identified. Concurrent immunotherapy does not appear to increase the risk of radionecrosis and may improve local control. These data further support the safety and synergistic efficacy of stereotactic radiosurgery with concurrent immunotherapy.
PMID: 37091181
ISSN: 2234-943x
CID: 5464962

Rindopepimut with Bevacizumab for Patients with Relapsed EGFRvIII-Expressing Glioblastoma (ReACT): Results of a Double-Blind Randomized Phase II Trial [Comment]

Reardon, David A; Desjardins, Annick; Vredenburgh, James J; O'Rourke, Donald M; Tran, David D; Fink, Karen L; Nabors, Louis B; Li, Gordon; Bota, Daniela A; Lukas, Rimas V; Ashby, Lynn S; Duic, J Paul; Mrugala, Maciej M; Cruickshank, Scott; Vitale, Laura; He, Yi; Green, Jennifer A; Yellin, Michael J; Turner, Christopher D; Keler, Tibor; Davis, Thomas A; Sampson, John H
PURPOSE/OBJECTIVE:Rindopepimut is a vaccine targeting the tumor-specific EGF driver mutation, EGFRvIII. The ReACT study investigated whether the addition of rindopepimut to standard bevacizumab improved outcome for patients with relapsed, EGFRvIII-positive glioblastoma. PATIENTS AND METHODS/METHODS:In this double-blind, randomized, phase II study (NCT01498328) conducted at 26 hospitals in the United States, bevacizumab-naïve patients with recurrent EGFRvIII-positive glioblastoma were randomized to receive rindopepimut or a control injection of keyhole limpet hemocyanin, each concurrent with bevacizumab. The primary endpoint was 6-month progression-free survival (PFS6) by central review with a one-sided significance of 0.2. RESULTS:< 0.0001). CONCLUSIONS:.
PMID: 32034072
ISSN: 1078-0432
CID: 4379422

An early feasibility study of the Nativis Voyager® device in patients with recurrent glioblastoma: first cohort in US

Cobbs, Charles; McClay, Edward; Duic, J Paul; Nabors, L Burt; Morgan Murray, Donna; Kesari, Santosh
AIM:device in patients with recurrent glioblastoma (rGBM). MATERIALS & METHODS:) 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. RESULTS: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. CONCLUSION:These data suggest that the Voyager is safe and feasible for the treatment of rGBM.
PMCID:6499016
PMID: 30547676
ISSN: 2045-0915
CID: 4014842

FEASIBILITY STUDY OF THE EMULATE THERAPEUTICS (TM) VOYAGER SYSTEM IN PATIENTS WITH RECURRENT GLIOBLASTOMA (GBM) [Meeting Abstract]

Barkhoudarian, Garni; Badruddoja, Michael; Blondin, Nicholas; Chen, Ricky; Chowdhary, Sajeel; Cobbs, Charles; Dowling, Anthony; Duic, Paul; Flores, John Paul; Fonkem, Ekokobe; McClay, Edward; Nabors, Louis; Salacz, Michael; Vaillant, Brian; Kesari, Santosh
ISI:000509478700110
ISSN: 1522-8517
CID: 4379442

Correction to: First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma [Correction]

Liau, Linda M; Ashkan, Keyoumars; Tran, David D; Campian, Jian L; Trusheim, John E; Cobbs, Charles S; Heth, Jason A; Salacz, Michael; Taylor, Sarah; D'Andre, Stacy D; Iwamoto, Fabio M; Dropcho, Edward J; Moshel, Yaron A; Walter, Kevin A; Pillainayagam, Clement P; Aiken, Robert; Chaudhary, Rekha; Goldlust, Samuel A; Bota, Daniela A; Duic, Paul; Grewal, Jai; Elinzano, Heinrich; Toms, Steven A; Lillehei, Kevin O; Mikkelsen, Tom; Walbert, Tobias; Abram, Steven R; Brenner, Andrew J; Brem, Steven; Ewend, Matthew G; Khagi, Simon; Portnow, Jana; Kim, Lyndon J; Loudon, William G; Thompson, Reid C; Avigan, David E; Fink, Karen L; Geoffroy, Francois J; Lindhorst, Scott; Lutzky, Jose; Sloan, Andrew E; Schackert, Gabriele; Krex, Dietmar; Meisel, Hans-Jorg; Wu, Julian; Davis, Raphael P; Duma, Christopher; Etame, Arnold B; Mathieu, David; Kesari, Santosh; Piccioni, David; Westphal, Manfred; Baskin, David S; New, Pamela Z; Lacroix, Michel; May, Sven-Axel; Pluard, Timothy J; Tse, Victor; Green, Richard M; Villano, John L; Pearlman, Michael; Petrecca, Kevin; Schulder, Michael; Taylor, Lynne P; Maida, Anthony E; Prins, Robert M; Cloughesy, Timothy F; Mulholland, Paul; Bosch, Marnix L
Following publication of the original article [1], the authors reported an error in the spelling of one of the author names. In this Correction the incorrect and correct author names are indicated and the author name has been updated in the original publication. The authors also reported an error in the Methods section of the original article. In this Correction the incorrect and correct versions of the affected sentence are indicated. The original article has not been updated with regards to the error in the Methods section.
PMCID:6026340
PMID: 29958537
ISSN: 1479-5876
CID: 3196472

First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma

Liau, Linda M; Ashkan, Keyoumars; Tran, David D; Campian, Jian L; Trusheim, John E; Cobbs, Charles S; Heth, Jason A; Salacz, Michael; Taylor, Sarah; D'Andre, Stacy D; Iwamoto, Fabio M; Dropcho, Edward J; Moshel, Yaron A; Walter, Kevin A; Pillainayagam, Clement P; Aiken, Robert; Chaudhary, Rekha; Goldlust, Samuel A; Bota, Daniela A; Duic, Paul; Grewal, Jai; Elinzano, Heinrich; Toms, Steven A; Lillehei, Kevin O; Mikkelsen, Tom; Walpert, Tobias; Abram, Steven R; Brenner, Andrew J; Brem, Steven; Ewend, Matthew G; Khagi, Simon; Portnow, Jana; Kim, Lyndon J; Loudon, William G; Thompson, Reid C; Avigan, David E; Fink, Karen L; Geoffroy, Francois J; Lindhorst, Scott; Lutzky, Jose; Sloan, Andrew E; Schackert, Gabriele; Krex, Dietmar; Meisel, Hans-Jorg; Wu, Julian; Davis, Raphael P; Duma, Christopher; Etame, Arnold B; Mathieu, David; Kesari, Santosh; Piccioni, David; Westphal, Manfred; Baskin, David S; New, Pamela Z; Lacroix, Michel; May, Sven-Axel; Pluard, Timothy J; Tse, Victor; Green, Richard M; Villano, John L; Pearlman, Michael; Petrecca, Kevin; Schulder, Michael; Taylor, Lynne P; Maida, Anthony E; Prins, Robert M; Cloughesy, Timothy F; Mulholland, Paul; Bosch, Marnix L
BACKGROUND:-L) to standard therapy for newly diagnosed glioblastoma. METHODS:After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS). RESULTS:For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months from surgery. Because of the cross-over trial design, nearly 90% of the ITT population received DCVax-L. For patients with methylated MGMT (n = 131), mOS was 34.7 months from surgery, with a 3-year survival of 46.4%. As of this analysis, 223 patients are ≥ 30 months past their surgery date; 67 of these (30.0%) have lived ≥ 30 months and have a Kaplan-Meier (KM)-derived mOS of 46.5 months. 182 patients are ≥ 36 months past surgery; 44 of these (24.2%) have lived ≥ 36 months and have a KM-derived mOS of 88.2 months. A population of extended survivors (n = 100) with mOS of 40.5 months, not explained by known prognostic factors, will be analyzed further. Only 2.1% of ITT patients (n = 7) had a grade 3 or 4 adverse event that was deemed at least possibly related to the vaccine. Overall adverse events with DCVax were comparable to standard therapy alone. CONCLUSIONS:Addition of DCVax-L to standard therapy is feasible and safe in glioblastoma patients, and may extend survival. Trial registration Funded by Northwest Biotherapeutics; Clinicaltrials.gov number: NCT00045968; https://clinicaltrials.gov/ct2/show/NCT00045968?term=NCT00045968&rank=1 ; initially registered 19 September 2002.
PMCID:5975654
PMID: 29843811
ISSN: 1479-5876
CID: 3156362

Eltrombopag for radiation-induced thrombocytopenia in a glioblastoma patient [Letter]

Duic, J Paul; Grewal, Jai; McConie, Kerry; Staszewski, Harry; Haas, Jonathan; Kesari, Santosh
PMID: 21833801
ISSN: 1573-7373
CID: 3484442

Phase 2 trial of talampanel, a glutamate receptor inhibitor, for adults with recurrent malignant gliomas

Iwamoto, Fabio M; Kreisl, Teri N; Kim, Lyndon; Duic, J Paul; Butman, John A; Albert, Paul S; Fine, Howard A
BACKGROUND: : Glioma cells secrete glutamate and also express alpha-amino-3-hydroxy-5 methyl-4-isoxazolepropionate (AMPA) glutamate receptors, which contribute to the proliferation, migration, and neurotoxicity of malignant gliomas. Talampanel is an oral AMPA receptor inhibitor with excellent central nervous system penetration and good tolerability in clinical trials for epilepsy and other neurologic disorders. METHODS: : A phase 2 trial was conducted to evaluate the efficacy of talampanel in patients with recurrent malignant glioma as measured by 6-month progression-free survival (PFS6). RESULTS: : Thirty patients (22 with glioblastomas [GBMs] and 8 with anaplastic gliomas [AGs]; 63% men) with median age of 51 years (range, 20-67 years) and a median Karnofsky performance scale of 80 were included. Patients tolerated treatment well, and most adverse events were mild and reversible; the most common toxicities were fatigue (27%), dizziness (23%), and ataxia (17%). There was only 1 partial response (5%) reported in the GBM stratum and none among AG patients. At a median follow-up of 13 months, 28 patients (93%) had died. The PFS6 was 4.6% for the initial 22 GBM patients, and the study was terminated early due to treatment futility; the PFS6 was 0% for 8 AG patients. The median PFS was 5.9 weeks for GBM and 8.9 weeks for AG patients. The median overall survival was 13 weeks for GBM patients and 14 months for AG patients. CONCLUSIONS: : Talampanel was well-tolerated but had no significant activity as a single agent in unselected recurrent malignant gliomas. Cancer 2010. Published 2010 by the American Cancer Society.
PMCID:2846997
PMID: 20143438
ISSN: 0008-543x
CID: 531932