This document summarizes results from a clinical trial evaluating the efficacy of adding temozolomide chemotherapy to radiation therapy for the treatment of glioblastoma. The trial involved 573 patients randomized to receive either radiation therapy alone or radiation therapy plus temozolomide. The addition of temozolomide resulted in a statistically significant improvement in median survival (14.6 months vs 12.1 months) and 2-year survival rates (26.5% vs 10.4%). Progression-free survival was also improved in the temozolomide group. Toxicity was found to be minimal. The results provide support for the standard of care now being radiation therapy plus temozolomide for newly diagnosed
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
When most normal cells grow
old or get damaged, they die, and new cells take their place. Sometimes, this
process goes wrong. New cells form when the body doesn't need them, and old or
damaged cells don't die as they should. The buildup of extra cells often forms
a mass of tissue called a growth or tumor.
Primary brain tumors can be benign or malignant:
Benign brain tumors do not contain cancer cells:
Usually, benign tumors can be removed, and
they seldom grow back.
Benign brain tumors usually have an obvious
border or edge. Cells from benign tumors rarely invade tissues around them.
They don't spread to other parts of the body. However, benign tumors can press
on sensitive areas of the brain and cause serious health problems.
Unlike benign tumors in most other parts of
the body, benign brain tumors are sometimes life threatening.
Benign brain tumors may become malignant.
Malignant brain tumors (also called brain
cancer) contain cancer cells:
Malignant brain tumors are generally more
serious and often are a threat to life.
They are likely to grow rapidly and crowd
or invade the nearby healthy brain tissue.
Cancer cells may break away from malignant
brain tumors and spread to other parts of the brain or to the spinal cord. They
rarely spread to other parts of the body.
Tumor Grade
Doctors group brain tumors by grade.
The grade of a tumor refers to the way the cells look under a microscope:
Grade I: The tissue is benign. The cells
look nearly like normal brain cells, and they grow slowly.
Grade II: The tissue is malignant. The
cells look less like normal cells than do the cells in a Grade I tumor.
Grade III: The malignant tissue has cells
that look very different from normal cells. The abnormal cells are actively
growing (anaplastic).
Grade IV: The malignant tissue has cells
that look most abnormal and tend to grow quickly.
Cells from low-grade tumors (grades I and
II) look more normal and generally grow more slowly than cells from high-grade
tumors (grades III and IV).
Over time, a low-grade tumor may become a
highgrade tumor. However, the change to a high-grade tumor happens more often
among adults than children.
You may want to read the NCI fact sheet Tumor
Grade.
Types of Primary Brain
Tumors
There are many types of primary brain
tumors. Primary brain tumors are named according to the type of cells or the
part of the brain in which they begin. For example, most primary brain tumors
begin in glial cells. This type of tumor is called a glioma.
Among adults, the most common types are:
Astrocytoma:
The tumor arises from star-shaped glial cells called astrocytes.
It can be any grade. In adults, an astrocytoma most often arises in the
cerebrum.
Grade I or II astrocytoma: It may be called
a low-grade glioma.
Grade III astrocytoma: It's sometimes
called a high-grade or an anaplastic astrocytoma.
Grade IV astrocytoma: It may be called a glioblastoma or
malignant astrocytic glioma.
Meningioma:
The tumor arises i
This PPT presentation talks about osteosarcoma from the clinical point of view, summarizing the recent guidelines in diagnosis and treatment of osteosarcoma.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
Conformal Radiotherapy in Head and neck cancers is essential in terms of improving quality of life and local control in this era. This presentation aimed at giving an overview of conformal radiotherapy and its role in HNC to a 'general audience'.
Aim of this ppt presentation:
To understand the standard of care for both GBM and anaplastic glioma.
To know what is the new advances and modifications to the standard of care?
Contents:
Introduction: 2 slides.
GBM:
Epidemiology: 1 slide.
Molecular biology & New trends: 5 slides
EORTC/NCIC trial: 10 slides.
MGMT: 1 slide.
Evidence-based medicine: 6 slides.
Avastin in GBM: 2 slides.
Novocure (TTF): 2 slides.
Gliadel (BCNU) wafers: 1 slide.
Anaplastic astrocytoma: 7 slides
Take home message.
High Risk disease is defined as “apparent localized cancer that has a high propensity of micro-metastatic disease” (cancer that is not visible on convention radiography, such as bone and CT scans). These cancers, once removed via radiation or surgery, are likely to "return," but in fact, they were never removed in the first place because the cancer cells were outside the treated region.
Therefore, successful eradication of high risk disease requires both aggressive local control and systemic treatment with androgen deprivation therapy and extended field radiation. This lecture will review the most up-to-date data on dose-intensity radiation therapy, pelvic radiation, surgery with adjuvant radiation, and adjuvant hormone therapy. Finally, data on experimental chemotherapy and abiraterone (Zytiga) will be presented.
General management
Management of low grade gliomas: overview
Pilocytic astrocytoma
non pilocytic/diffuse infiltrating gliomas
Management of high grade gliomas: overview
Anaplastic gliomas
Glioblastoma multiformae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
11. Age-Standardized Incidence Rate per (100,000 )population for Male
cancers ( all sites) , Jordan compared with other countries .
12.
13.
14.
15.
16.
17.
18. Radiotherapy plus Concomitant &
Adjuvant Temozolomide for
Glioblastoma
Roger Stupp, M.D., Warren P.
Mason, M.D., et al,
European Organisation for Research and
Treatment of Cancer Brain Tumor and
Radiotherapy Groups and the National Cancer
Institute of Canada Clinical Trials Group
Volume 352 Issue 10 , 10 March 2005, Pages 987996
19. Introduction
Treatment of Glioblastoma
Surgical resection
,safely feasible
Adjuvant
Radiotherapy
adjuvant carmustine,
(a nitrosourea drug )
used in the USA .
No survival benefit
Compared with RTX
alone
randomized phase 3 trial of nitrosourea -based adjuvant chemotherapy
Stupp R, et al . ASCO 2003 , American Society of Clinical Oncology, 2003:779-88.
20. Introduction
Treatment of recurrent gliomas
Temozolomide
as a single agent
Antitumor
activity
reduces the DNA-repair
enzyme (MGMT) in
tumor tissue
longer survival especially
patients with glioblastoma
Hegi ME, et al.. Clin Cancer Res 2004;10:1871-1874
21. Introduction
pilot phase 2 trial
in patients Glioblastoma
Concomitant:
temozolomide
+
fractionated
radiotherapy
adjuvant
Temozolomide
6 cycles
two-year survival rate,
31 %
promising clinical
activity
Stupp R et al.. J Clin Oncol 2002;20:1375-1382
22. therefore the (EORTC) & the (NCIC)
initiated this trial
Concomitant:
temozolomide
+
fractionated
radiotherapy
adjuvant
Temozolomide
6 cycles
phase 3 trial
in patients Glioblastoma
Comparing
Radiotherapy
alone
23. the (EORTC) & the (NCIC) trial
patients
The median age :
56 years
Eligibility criteria :
*newly diagnosed
glioblastoma
(grade IV astrocytoma)
*p/s 2 or less
*adequate renal ,
Hematologic & hepatic
function
baseline examination:
1.
CT-scan or MRI
2.
CBC & chemistry
3.
physical examination
4.
pathology review
84% underwent
debulking surgery
573 patients
from 85 institutions
in 15 Countries
pathological review
confirmed in 93 %
Histologic slides were
submitted for 85%
24. the (EORTC) & the (NCIC) trial
Methodology & Design
573 patients from 85
institutions in 15
Countries
From August 2000 until
March 2002
Radiotherapy
(286 patients)
Randomly
assigned to
receive
End point :
Overall survival
Radiotherapy
+temozolomide
(287 patients)
25. the (EORTC) & the (NCIC) trial
treatment - Radiotherapy alone
Radiotherapy
60 Gy/ 30 fractions /6 weeks
day 1
7
5
14
21
28
35
43
week 1
week 2
week 6
week 3
week 5
week 4
GTV (tumor without edema )
CTV (GTV+ 2-3 cm margins)
Planned with CT-scan
+ 3D planning system
Radiotherapy delivered
with 6MV linear & more
26. the (EORTC) & the (NCIC) trial
treatment - RTx+Temodal
Radiotherapy
60 Gy/ 30 fractions /6 weeks
day 1
7
5
14
21
28
35
43
week 1
week 2
week 6
week 3
week 5
week 4
GTV (tumor + edema )
CTV (GTV+ 2-3 cm margins)
Planned with CT-scan
+ 3D planning system
Radiotherapy delivered
with 6MV linear & more
27. the (EORTC) & the (NCIC) trial
treatment - RTx+Temodal
Radiotherapy
60 Gy/ 30 fractions /6 weeks
day 1
7
5
14
21
28
Break
35
43
week 1
Temodal
75 mg/m2
Daily 7 D
week 2
Temodal
75 mg/m2
Daily 7 D
week 6
week 3
Temodal
75 mg/m2
Daily 7 D
week 5
week 4
Temodal
75 mg/m2
Daily 7 D
Temodal
75 mg/m2
Daily 7 D
Temodal
75 mg/m2
Daily 7 D
4 week
Adjuvant
Temodal
Temodal
5 days every 28
days for 6 cycles
150 mg/m2 cycle 1
200 mg/m2 cycle 2
200 mg/m2 cycle 3
200 mg/m2 cycle 4
200 mg/m2 cycle 5
200 mg/m2 cycle 6
GTV (tumor without edema )
CTV (GTV+ 2-3 cm margins)
Planned with CT-scan
+ 3D planning system
Radiotherapy delivered
with 6MV linear & more
28. the (EORTC) & the (NCIC) trial
Results
At a median follow up 28 months
480 pts (84%) died
Median survival:
RTx alone :12.1 months
RTx+Temadal :14.6 months
The 2 yrs survival :
RTx alone :10.4%
RTx+Temadal :26.5%
29.
30. the (EORTC) & the (NCIC) trial
Results
The median progressionfree survival was:
RTx alone : 5.0 months
RTx+Temadal : 6.9 months
The progression-free survival
at 12 months :
RTx alone :9.1%
RTx+Temadal :26.9%
31.
32. adverse events
No grade 3 or 4 hematologic
toxic effects were observed in
the radiotherapy group
During adjuvant
During concomitant
temozolomide therapy
temozolomide therapy
33. The effects of TEMODAL and MGMT on methylation status of DNA.
Adapted from MGMT and Objection Handling.ppt
34. TEMODAL is an alkylating agent that kills
cells by adding a methyl group to DNA.
DNA damage caused by TEMODAL
culminates in cell death through
apoptosis. One enzyme that is known to
repair the DNA damage caused by
alkylating agents such as TEMODAL is O6methylguanine-DNA methyltransferase
(MGMT
35. MGMT is expressed in all cells. MGMT
repairs damaged DNA by removing methyl
groups from the O6 position of DNA
guanines. Once MGMT has removed one
methyl group, it is inactivated. It would seem
reasonable therefore that lower MGMT levels
in tumour cells might result in a higher
response following TEMODAL administration,
and conversely high MGMT levels might
translate into a lower response rate.
36. the (EORTC) & the (NCIC) trial
treatment - Conclusion
the addition of temozolomide to radiotherapy provides
a statistically significant survival benefit
with minimal toxicity
the regimen of radiotherapy plus temozolomide
should serve as :
the new platform from which we need to explore for
new regimens for treating malignant gliomas.
Thank you
38. A phase II trial of lithium, bevacizumab, temozolomide, and
radiation for newly diagnosed glioblastomas (GBM)
. This phase II study evaluated the
safety and efficacy of using lithium
and bevacizumab (BEV) in newly
diagnosed GBM.
Conclusions: The strategy of
targeting angiogenesis and invasion
simultaneously in newly diagnosed
GBM is effective and feasible. Clinical
trial information: NCT01105702.
39. Final results of a single-arm phase II study of
bevacizumab and temozolomide following
radiochemotherapy in newly dignosed adult
glioblastoma patients
This study evaluated efficacy and
safety of bevacizumab (BEV) added
to the post-radiation treatment phase
for patients with newly diagnosed
glioblastoma (GBM).
Participants received standard
radiation therapy (RT) within 6 weeks
of surgery, and concomitant
administration of temozolomide
(TMZ)
40. Four weeks after radiation, treatment
with TMZ (Days 1-5 of a 28 day cycle)
with BEV, (days 1 and 15 of a 28 day
cycle) was started, and continued until
disease progressed or adverse effects
indicated need to stop treatment.
41. ). Results suggest that the addition of
bevacizumab to the post-RT phase of
treatment improves both PFS and OS
for persons with GBM despite the high
percentage of participants being
unable to progress to post-radiation
treatment. Clinical trial information:
NCT005906
42. Temozolomide plus bevacizumab in elderly patients
with newly diagnosed glioblastoma and poor
performance status: An Anocef phase II trial
evaluated the efficacy and safety of the
combination of TMZ with bevacizumab
(BV) as an initial treatment for elderly
patients with GBM and KPS<70.
Conclusions: This study confirms that
TMZ-based treatment is of help in
elderly GBM patients with poor KPS.
However, the addition of bevacizumab
does not appear to be of benefit in term
of PFS and OS.
43. Survival benefit from bevacizumab in newly
diagnosed glioblastoma (GBM) according to
transcriptional subclasses.
Background: Genome-wide
transcriptional studies (TCGA and
others) have identified distinct GBM
molecular subtypes, but to date this
has not translated into prognostic or
therapeutic implications.
Bevacizumab has emerged as a new
treatment option for GBMs, although
a survival benefit has yet to be
demonstrated in unselected patients
(pts).
44. We analyzed outcomes from a
prospective phase II trial in newly
diagnosed GBM treated with
hypofractionated stereotactic
radiotherapy (HFSRT) combined with
temozolomide and bevacizumab, and
correlated with GBM transcriptional
subclasses.
45. Conclusions: We provide proof-ofprinciple that GBM transcriptional
classification is biologically and
therapeutically relevant, identifying
non pro-neural GBMs as the best
candidates for bevacizumab
treatment.
46. Our findings imply that angiogenesis
and tumor invasion mechanisms in
proneural tumors may be distinct
from other subtypes, and we suggest
such pts should not be offered
bevacizumab treatment upfront.
Future randomized trials focusing on
non-proneural tumors may finally
demonstrate a survival advantage for
bevacizumab in GBM. Clinical trial
information: NCT01392209.
47. Progression-free survival (PFS) and health-related quality
of life (HRQoL) in AVAglio, a phase III study of bevacizumab
(Bv), temozolomide (T), and radiotherapy (RT) in newly
diagnosed glioblastoma (GBM).
: GBM has a high disease burden and
poor prognosis, and impacts negatively
on HRQoL. Symptomatic therapies for
GBM, such as corticosteroids (CS), may
impact patient status negatively
Methods: AVAglio, a randomized,
double-blind, placebo (P)-controlled trial
in patients (pts) ≥18 yrs with newly
diagnosed GBM, evaluated the addition
of Bv or P
48. Bevacizumab in combination with TMZ in patients
with recurrent GBM: Final OS and PFS analysis
BEV provides a consistent clinical benefit
in the treatment of relapsing GBM in
terms of a delayed progression and
increased median overall survival
compared to historical controls. The aim
of this study is to evaluate the efficacy
and toxicity profile of the combination of
BEV with dose dense TMZ, reporting the
final results of PFS, OS and the toxicity
experienced
49. Conclusion: Although the
combination don’t met the previous
reported activity of BEV, 19% of
patients had longer survivals which
suggest the need to identify patients
that benefit for this treatment.
Clinical trial information:
NCT01115491
50. Tumor response based on adapted Macdonald criteria
and assessment of pseudoprogression (PsPD) in the
phase III AVAglio trial of bevacizumab (Bv) plus
temozolomide (T) plus radiotherapy (RT) in newly
diagnosed glioblastoma (GBM).
Conclusion: Addition of Bv to 1stline T/RT significantly improves ORR.
The rate of confirmed PsPD was low
in both arms. Clinical trial
information: NCT00943826
TEMODAL is an alkylating agent that kills cells by adding a methyl group to DNA. DNA damage caused by TEMODAL culminates in cell death through apoptosis. One enzyme that is known to repair the DNA damage caused by alkylating agents such as TEMODAL is O6-methylguanine-DNA methyltransferase (MGMT). MGMT is expressed in all cells. MGMT repairs damaged DNA by removing methyl groups from the O6 position of DNA guanines (see Figure 5-4). Once MGMT has removed one methyl group, it is inactivated. It would seem reasonable therefore that lower MGMT levels in tumour cells might result in a higher response following TEMODAL administration, and conversely high MGMT levels might translate into a lower response rate.