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NCI Presentations at the 2018 SNO Annual Meeting

, by NCI-CONNECT Staff

Dr. Mark Gilbert, Nicole Briceno and Dr. Terri Armstrong

Credit: NCI-CONNECT Staff

The 2018 Annual Meeting of the Society for Neuro-Oncology (SNO) was held November 15 to 18, 2018, in New Orleans. At the meeting, neuro-oncology scientists and clinicians discussed the latest advancements in neuro-oncology. The meeting had a record attendance of over 2,400 registrants. 

The NCI Center for Cancer Research Neuro-Oncology Branch was well represented at the meeting, with over 40 presentations throughout the four-day meeting. A synopsis of the NCI-CONNECT presentations is provided below.

Abstract Presentation: Objective Response and Clinical Benefit in Recurrent Ependymoma in Adults: Final Report of CERN 08-02: A Phase II Study of Dose-dense Temozolomide and Lapatinib

Mark Gilbert, M.D.

Ependymoma is a rare tumor for which the role of chemotherapy has not been established either for newly diagnosed or recurrent disease. We report on the first prospective adult clinical trial of chemotherapy for recurrent ependymoma.

50 adult patients were treated with the chemotherapy drugs temozolomide and lapatinib. Efficacy was determined using MRI imaging of either the brain or spine. Clinical benefit was evaluated using assessment of symptom burden and performance status. Primary endpoint was progression free survival. Additional endpoints included 12-month progression free survival rate, objective response and clinical benefit. 

Results from this study demonstrate evidence of clinical activity, including objective responses and a nearly 40% stable disease rate at one year, with improvement in disease-related symptoms. This combination regimen was well tolerated and should be considered as a standard salvage regimen for adult patients with recurrent ependymoma.

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Abstract Poster: A Descriptive Report of Patients with Rare Central Nervous System (CNS) Cancers on an NCI-CONNECT Cancer Moonshot Immune Checkpoint Inhibitor Trial

Lisa Boris and Chrissy Bryla

There is increasing interest in the use of immunotherapy in rare CNS tumors, but limited experiences in the clinical evaluation of imaging findings and treatment toxicity in these patients. A phase II clinical trial of Nivolumab, a PD-1 inhibitor, in eleven rare CNS tumors was developed by the NCI-CONNECT program. 

The purpose of this report is to describe both patient-reported outcome and standardized assessment of these patient’s treatment toxicities and correlate with imaging findings.

For these 13 patients, Nivolumab was well tolerated with no CNS specific adverse events. MRI changes were not associated with change in symptom burden, but was associated with significant worsening in patient-reported outcome, specifically in walking, pain, seizures, cognitive or autonomic symptoms. Evaluation of cardinal symptoms associated with progression on immunotherapy may be meaningful in patients with rare CNS tumors.

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Abstract Poster: Nucleic Acid Adequacy from Archived Formalin-fixed Paraffin Embedded (FFPE) Tumor Tissue for Next-generation Sequencing (NGS) in National Cancer Institute (NCI) - Natural History Study (NHS) of Primary CNS Tumor 

Nicole Briceno

A unified data collection system for reviewing the clinical trajectory of patients and their molecular pathology is of significant diagnostic, research, and therapeutic importance. The NCI-NHS follows primary CNS tumor patients throughout their disease.

A targeted NGS panel was developed for clinical screening using archived FFPE tissue. Due to the nature of study, available specimens range in age and source, posing a considerable challenge to obtaining an adequate quality and quantity for analysis.

Tumor blocks or unstained slides were received for neuro-pathologist to review and score tumor tissue and DNA and RNA were extracted. Tissue material from 227 patients was submitted. There was no significant difference between NIH and outside cases. Clinically significant molecular findings were reported in 81% of the cases across 18 diagnoses. This study confirms the feasibility of using archived materials for molecular analysis with analyzable results.

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Abstract Poster: Preliminary Examination of Confirmed Glioma Risk Factors Among Ependymoma Patients in the Neuro-Oncology Branch Natural History Study (NOB-NHS) and Risk and Outcomes Study (ROS) 

Alvina Acquaye

The Glioma International Case-Control (GICC) study is the largest study to date examining genetic and environmental risk factors for adult gliomas. Inverse associations have been repeatedly confirmed for allergies, atopic skin diseases, and viral infections. Evaluations of these risk factors, specifically ependymoma, has not been completed, due to the rarity compared to other glioma types. Therefore, the purpose of this report is evaluating the associations of these confirmed glioma risk factors with ependymomas.

128 adult ependymoma patients enrolled in the NOB-ROS. Survey sections related to history of asthma/allergies, common infectious diseases, and regular antihistamine/anti-inflammatory use were examined. Ependymoma patients exposed to these factors were calculated and compared glioma cases.

We have found that asthma and allergy effects may be more pronounced among ependymoma cases compared to gliomas overall. However, effects of antihistamines and anti-inflammatory drugs are much worse in ependymoma cases compared to published effects in all cases. This is the first report in adult ependymoma patients exploring risk factors reported in other gliomas and provides preliminary understanding of potential differences in ependymomas. Further analysis should be explored to identify significant areas of concern.

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Abstract Poster: Capturing the Primary Brain Tumor (PBT) Patient's Experience of Body Image Dissatisfaction: Report from the Neuro-Oncology Branch - Natural History Study (NOB-NHS) 

Alvina Acquaye

Body image dissatisfaction is associated with difficulty coping and adjustment in patients with other solid tumors. Although PBT patients may be at increased risk due to the visible disfigurement and debilitating nature of the disease, there is limited research in this patient group. The purpose of this report is to present the qualitative analysis of data captured on the NOB-NHS Body Image Study. 

100 patients participated by completing structured questionnaires and open-ended responses, asking: How have the changes affected you? Only 10 indicated no body image issues. Five dominant themes (lifestyle changes, symptom effects, negative & positive outlook, changes in appearance) characterized participant description of body image since their diagnosis. A number of patients (28%) expressed a hindrance within their lifestyle (altered mobility, independence, activity, and changes in relationships). Participants described symptom effects (weight gain, fatigue, pain, vision changes) contributing to dissatisfaction throughout their disease. Specific changes in appearance (hair loss, indentation on head, skin dryness) were also problematic factors affecting adjustment and coping. A negative outlook (9%) (self-conscious, feeling ashamed or vulnerable) magnified awareness of long-term permanent changes, but some (8%) described the implementation of a positive outlook (using exercise and hope) allowing for acceptance of these changes.

These findings offer insight from the patient’s perspective on identified physical, mental and treatment-related factors regarding body image concerns and the scope of issues faced by PBT patients. Understanding patient concerns allows for a multidimensional approach in management of key areas with the goal of improving overall quality of life

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