Elderly glioblastoma patients: Survival analysis according adjuvant therapy and tumor molecular analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14046-e14046
Author(s):  
Maria Angeles Vaz ◽  
Isaac Ceballos Lenza ◽  
Sonia Del Barco Berron ◽  
Maria Cruz Martin Soberón ◽  
Oscar Gallego Rubio ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Promoter Methylation ◽  
Systemic Treatment ◽  
Methylation Status ◽  
Mgmt Promoter Methylation ◽  
Mgmt Promoter ◽  
Mgmt Promoter Status ◽  
Mgmt Promoter Methylation Status

e14046 Background: Glioblastoma (GBM) grade IV represents the most frequent and aggressive primary brain tumor. Despite complete surgical resection, GBM infiltrative potential leads to local recurrence rates of around 100%. Standard treatment with adjuvant chemotherapy (CT) and radiotherapy (RT) according Stupp regimen aims to reduce relapse and improve survival, but toxicities associated with these therapies represent a problem in elderly unfit population. O6-Methylguanine-DNA methyltransferase (MGMT) promoter methylation status has been recognized as a predictive factor of response to alkylating agents as temozolomide. We aimed to compare overall survival (OS) results in elderly GBM patients according with MGMT promoter status and systemic treatment after surgery. Methods: We performed a database from the information available from RETSINE (Registro Nacional Español de Tumores de Sistema Nervioso Central). We selected ≥ 65 years GBM diagnosed patients. Relevant information was tumor MGMT promoter methylation status and adjuvant CT and/or RT after resection. Kaplan- Meier analysis was performed. Selected outcome was OS and 95% confidence intervals (CI) and p value < 0.05 were used as measures of statistical significance. Results: We identified 400 eligible GBM patients diagnosed ≥ 65 years (male = 232- 58%; female = 168-42% ). According tumor MGMT status: 125 (31.3%) methylated tumors, 115 (28.7%) non methylated and 160 unknown MGMT status. Included population median age was 72 years (65-88 years). Median global population OS was 7.93 months (IC95% 6.84-9.02). Survival analysis showed better OS for methylated tumors group, median OS 7.33 (IC 95%4.1-10.56) vs. unmethylated OS 7.06 (IC95% 4.9-9.1) (p = 0.021). Survival analysis in methylated patients showed improved OS in patients treated with RT + CT vs. no adjuvant therapy. Median OS for methylated patients treated with CT + RT was 11.46m (IC95%7.6-15.9) vs 9.6 months with only RT(IC95%3.67-7.26) and 2.1m with no treatment (IC95%2.03-3.76) p = 0,00. Unmethylated patients median OS was 9.36m (IC95%3.67-7.26) for RT-CT, 5.4 m (IC95%2.37-8.42) for RT only and 2.76 (IC95% 1.37-4.15) for no treatment p = 0.00. Conclusions: Elderly GBM patients have similar treatment options than young patients and comprise surgical resection, RT and alkylating CT with temozolomide. Comorbidities and performance status have relevant implications in elderly population treatment decisions. The MGMT promoter status has been described as a prognostic and predictive marker of response to temozolomide. In our series both methylated and unmethylated patients can benefit with systemic treatment.

scholarly journals NIMG-38. NON-INVASIVE PREDICTION OF MGMT PROMOTER METHYLATION USING COMBINED FET PET/MRI RADIOMICS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii156-ii156
Author(s):  
Philipp Lohmann ◽  
Anna-Katharina Meissner ◽  
Jan-Michael Werner ◽  
Gabriele Stoffels ◽  
Martin Kocher ◽  
...  
Keyword(s):  
Promoter Methylation ◽  
Methylation Status ◽  
Mgmt Promoter Methylation ◽  
Test Dataset ◽  
Fet Pet ◽  
Promoter Methylation Status ◽  
Non Invasive ◽  
Mgmt Promoter ◽  
Amino Acid Pet ◽  
Mgmt Promoter Methylation Status

Abstract BACKGROUND Recently, the Response Assessment in Neuro-Oncology (RANO) Working Group emphasized the additional diagnostic value of amino acid PET in addition to MRI. However, the number of studies using amino acid PET/MRI radiomics is still low. We investigated the potential of combined O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET/MRI radiomics for the non-invasive prediction of the O6-methylguanine-DNA methyl-transferase (MGMT) promoter methylation status in glioma patients. METHODS Seventy-one patients with newly diagnosed glioma (predominantly WHO grade III and IV glioma, 82%) underwent a hybrid FET PET/MRI scan. Forty-six patients (65%) had a methylated MGMT promoter. The tumor and tumor subregions were manually segmented on conventional MRI. In total, 199 standardized features were obtained from FET PET, contrast-enhanced T1-weighted, T2-weighted, and fluid attenuated inversion recovery (FLAIR) MRI. After feature extraction and data normalization, patients were randomly assigned to a training and a test dataset for final model evaluation in a ratio of 70/30, with a balanced distribution of the MGMT promoter methylation status. Feature selection was performed by recursive feature elimination using random forest regressors. For the final model generation, the number of features was limited to seven to avoid data overfitting. Different algorithms for model generation were compared, and the model performance in the training data was assessed by 5-fold cross-validation. Finally, the best performing models were applied to the test dataset to evaluate the robustness of the models. RESULTS In the test dataset, the best radiomics signatures obtained from MRI or FET PET alone achieved diagnostic accuracies for the prediction of the MGMT promoter methylation of 64% and 70%, respectively. In contrast, the highest diagnostic accuracy of 83% was obtained by combining FET PET and MRI features. CONCLUSION Combined FET PET/MRI radiomics allows the non-invasive prediction of the MGMT promoter methylation status in patients with gliomas, providing more diagnostic information than either modality alone.

scholarly journals MGMT Promoter Methylation and Parathyroid Carcinoma

2019 ◽  
Vol 3 (11) ◽  
pp. 2114-2122
Author(s):  
Sara Storvall ◽  
Eeva Ryhänen ◽  
Ilkka Heiskanen ◽  
Tiina Vesterinen ◽  
Frank V Bensch ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Promoter Methylation ◽  
Parathyroid Carcinoma ◽  
Methylation Status ◽  
Mgmt Promoter Methylation ◽  
Promoter Methylation Status ◽  
Mgmt Promoter ◽  
Atypical Parathyroid Adenoma ◽  
Mgmt Promoter Methylation Status

Abstract Context Parathyroid carcinoma (PC) is extremely rare. Prognosis is poor, with no known evidence-based systemic therapies. We previously reported complete remission in a patient with metastasized parathyroid carcinoma and high tumor MGMT promoter methylation status who was treated with temozolomide. Objective To study MGMT promoter methylation status in an additional set of aggressive parathyroid tumors. Design/Setting The study included 12 patients: 7 with sporadic and 5 with familial primary hyperparathyroidism (two of the latter carried a CDC73 gross deletion). Patient 9 is the previously described patient with PC and high MGMT methylation status. Her daughter (patient 12) had surgery for severe primary hyperparathyroidism due to atypical parathyroid adenoma during pregnancy. Eleven patients thus had PC and one had atypical parathyroid adenoma. MGMT promoter methylation status was determined from DNA extracted from primary (n = 10) or metastatic (n = 2) tumors. A mean methylation level >20% was considered high. Patient 11 had metastatic PC and received temozolomide cycles. Results Only the previously published patient (patient 9) had high tumor MGMT promoter methylation status. This was not a characteristic of the atypical parathyroid adenoma of the daughter (patient 12). Patient 11 (CDC73 intragenic deletion) has disseminated PC, low MGMT promoter methylation, and stable disease on follow-up after temozolomide treatment. Conclusion High MGMT promoter methylation status seems rare in PC. However, as demonstrated in other neuroendocrine tumors, some patients with disseminated PC might benefit from temozolomide. Demonstration of high methylation status could be a predictor of positive response to temozolomide treatment.

scholarly journals Recycling drug screen repurposes hydroxyurea as a sensitizer of glioblastomas to temozolomide targeting de novo DNA synthesis, irrespective of molecular subtype

2017 ◽  
Vol 20 (5) ◽  
pp. 642-654 ◽  
Author(s):  
Jian Teng ◽  
Seyedali Hejazi ◽  
Lotte Hiddingh ◽  
Litia Carvalho ◽  
Mark C de Gooijer ◽  
...  
Keyword(s):  
Promoter Methylation ◽  
Dna Methyltransferase ◽  
Methylation Status ◽  
Primary Cultures ◽  
Mgmt Promoter Methylation ◽  
In Vivo Models ◽  
Promoter Methylation Status ◽  
Mgmt Promoter ◽  
Mgmt Promoter Methylation Status

Abstract Background Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumor. Standard-of-care treatment involves maximal surgical resection of the tumor followed by radiation and chemotherapy (temozolomide [TMZ]). The 5-year survival rate of patients with GBM is &lt;10%, a colossal failure that has been partially attributed to intrinsic and/or acquired resistance to TMZ through O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status in the tumor. Methods A drug screening aimed at evaluating the potential recycling and repurposing of known drugs was conducted in TMZ-resistant GBM cell lines and primary cultures of newly diagnosed GBM with different MGMT promoter methylation status, phenotypic/genotypic background and subtype, and validated with sphere formation, cell migration assays, and quantitative invasive orthotopic in vivo models. Results We identified hydroxyurea (HU) to synergize with TMZ in GBM cells in culture and in vivo, irrespective of MGMT promoter methylation status, subtype, and/or stemness. HU acts specifically on the S-phase of the cell cycle by inhibiting the M2 unit of enzyme ribonucleotide reductase. Knockdown of this enzyme using RNA interference and other known chemical inhibitors exerted a similar effect to HU in combination with TMZ both in culture and in vivo. Conclusions We demonstrate preclinical efficacy of repurposing hydroxyurea in combination with TMZ for adjuvant GBM therapy. This combination benefit is of direct clinical interest given the extensive use of TMZ and the associated problems with TMZ-related resistance and treatment failure.

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