ASCO 2021: Nerve Tumor Review (Part 2)

1.
A new inhibitor of mTOR, which can effectively treat meningioma

1.
A new inhibitor of mTOR, which can effectively treat meningioma 1.
A new inhibitor of mTOR, which can effectively treat meningioma

Grade II/III meningiomas account for about 20% of tumors, have a high recurrence rate, and have no approved medical treatments
.

Historically, the 6-month progression-free survival (PFS-6) of these tumors was 25%

Scott Randall Plotkin of Harvard University and others studied the effect of vistusertib (mTOR inhibitor) on patients with advanced or relapsed grade II/III meningioma (NCT03071874)
.

Vistusertib was taken orally for two consecutive days a week, 125 mg each time, twice a day

immunity

25 patients were followed up for 6 months or until tumor progression
.

The median duration of treatment is 6.

PFS-6 is 51.
5% (CI, 29.
3%-70.
0%)
.

Adverse events that are at least likely to be related to vistusertib with a frequency> 10% include nausea (54%); fatigue (36%); hypophosphatemia (29%); diarrhea, anorexia, dry mouth, and hypertriglyceridemia (all 14%); hypertension, vomiting, elevated ALT, constipation, and weight loss (both 11%)

Vistusertib treatment is associated with an increase in PFS-6, exceeding the RANO target of 35% for recurrent high-grade meningiomas .
In this patient group, adverse events are acceptable
.

To determine the biological factors associated with the reaction

Exceeds Rano's 35% target for recurrent high-grade meningiomas Exceeds Rano 's 35% target for recurrent high-grade meningiomas

Source: Scott Randall Plotkin et al.

J Clin Oncol 39, 2021 (suppl 15; abstr 2024)

2.

Pembrolizumab, a new drug, may be expected to treat meningioma

2.
Pembrolizumab new drug, or is expected to treat meningioma 2.

Blood vessel

Shlomit Yust-Katz and others from Israel explored the effect of pembrolizumab in the treatment of refractory atypical/asexual meningioma (RAM) and HPC patients
.

All patients received pembrolizumab (200mg, once every 3 weeks)
.

The primary endpoint is 6 months and 12 months of progression-free survival (PFS)

Preliminary results of the experiment: As of February 2021, 12 patients have participated in this study (2 HPC patients, 10 RAM patients)
.

After a median follow-up of 18.

One of the responders had HPC and had been stable for 30 months, while the second patient had atypical meningioma and had been stable for 13 months
.
The median survival has not yet been reached; the 1-year survival rate is 82.
5%
.
Grade 3 toxicities include hyperglycemia, elevated liver enzymes, and fatigue (which did not lead to treatment discontinuation).
There are no Grade 4 or 5 toxicity
.
PD-L1, mutation burden, MSI and other genomic analysis are still in progress
.

It can be seen that Pembrolizumab induced a low response rate of RAM and HPC
.
However, a subgroup of patients may benefit from this treatment and have a longer response period
.
To define this subgroup, further molecular research is needed
.

Source: Shlomit Yust-Katz et al.

J Clin Oncol 39, 2021 (suppl 15; abstr 2064)

3.
The therapeutic effect of Trabectidine on meningiomas still needs to be explored

3.
The therapeutic effect of Trabectedin on meningiomas still needs to be explored 3.
The therapeutic effect of Trabectedin on meningioma still needs to be explored

The EORTC Brain Tumor Group studied the activity, safety and quality of life of the drug Yondelis in patients with recurrent high-grade meningioma
.
Trabectedin (trabectedin) is originally from the Caribbean sea squirt, Ecteinascidia turbinata, and is currently produced through a fully synthetic method
.

Adult patients with a histological diagnosis of WHO grade II or III meningioma, who have undergone the largest feasible surgery and radiotherapy, have radiologically recorded progress, and are randomly assigned to receive intravenous trabectidine (1.
5 mg) at a 2:1 ratio /m2, once every three weeks) or local standard care (LOC)
.
The primary endpoint is progression-free survival (PFS)
.

diagnosis

Within 22.
1 months, the study group randomly selected 90 patients (29 in the LOC group and 61 in the paper clip group) from 35 institutions in 9 countries
.
In the LOC group, the following treatments were implemented: hydroxyurea (n=11), bevacizumab (n=9), none (n=4), chemotherapy (n=3), somatic peptide analogs (n= 1) Combination chemotherapy and somatic peptide analogs (n=1)
.

Among 71 PFS events, the median PFS in the LOC group was 4.
17 months and that in the trabectidine group was 2.
43 months (hazard ratio for progression [HR], 1.
42; 80% CI, 1.
00-2.
03; P=0.
204) The PFS-6 rate in the LOC group was 29.
1% (95% CI, 11.
9%-48.
8%), and the trabectedin group was 21.
1% (95% CI, 11.
3%-32.
9%)
.

In LOC, the median OS was 10.
61 months, and in the trabectedin group it was 11.
37 months (death HR, 0.
98; 95% CI, 0.
54-1.
76; P=0.
94)
.
Grade 3-5 adverse events occurred in 44.
4% (18.
5% related, 4 serious adverse events, 0 deaths) of LOC patients and 59% (32.
8% related, 57 serious adverse events and 2 deaths from poisoning) Trabectedin Group of patients
.

In this first prospective randomized trial of recurrent grade II or grade III meningioma, trabectidine did not improve PFS and OS , and compared with LOC treatment, it was significantly more toxic
.
The data collected in this study can provide information reference for future clinical trials
.

source:

, Trabectedin did not improve PFS and OS , Trabectedin did not improve PFS and OS

4.
After ribose polymerase (PARP) inhibitor treatment of brain metastases, the patient's basic condition is stable

4.
After ribose polymerase (PARP) inhibitor treatment of brain metastases, the patient's basic state is stable 4.
After ribose polymerase (PARP) inhibitor treatment of brain metastases, the patient's basic state is stable

In the EMBRACA trial (NCT01945775), the poly-ADP-ribose polymerase (PARP) inhibitor TALA significantly improved progression-free survival (PFS) compared with PCT (chemotherapy) (8.
6 vs 5.
6 mo; HR [95% CI] 0.
54 [0.
41-0.
71]; P< 0.
0001)
.
Patient-reported results are in favor of TALA, and the most common adverse events include anemia, fatigue, and nausea
.
A previous subgroup analysis found that compared with PCT in patients with a history of central nervous system metastasis, TALA has improved PFS and an improved objective response rate (ORR)
.

This retrospective subgroup analysis further explored the clinical characteristics and results of patients with a history of central nervous system metastasis in EMBRACA
.

Patients were randomly assigned to TALA or PCT at a ratio of 2:1
.
This includes patients with adequately treated and stable central nervous system metastases that do not require corticosteroids
.
This analysis evaluated intracranial ORR and best overall response (BOR), based on the investigator's assessment of patients with intracranial disease at baseline and overall survival
.

In the intention-to-treat (ITT) population, 63 patients (43/287 TALA and 20/144 PCT) had a history of central nervous system metastasis, of which 33 (11.
5%) patients (TALA) and 15 (10.
4%) patients (PCT) Intracranial disease at baseline
.
The intracranial ORR of patients with intracranial disease at baseline and no complete or partial response was confirmed was 18.
2% (TALA) vs 20.
0% (PCT)
.

Among patients with intracranial disease at baseline, the stable intracranial disease rate of TALA was 69.
7%, and the PCT was 33.
3%
.
In patients with a history of central nervous system metastasis, the median OS of TALA was 12.
9 months (95% CI: 9.
4-15.
6), and the PCT was 13.
4 months (95% CI: 8.
8-17.
6)
.

In the safe population, the median treatment time (range) of TALA was 5.
0 months, while the PCT was 2.
1 (0.
4-6.
9) months
.

In this subgroup analysis, the baseline characteristics of TALA or PCT treatment in patients with a history of central nervous system metastasis were comparable
.
More patients with intracranial diseases are in stable condition after receiving TALA and PCT treatment
.
In patients with intracranial diseases, the intracranial ORR of TALA was 18.
2%, and the PCT was 20.
0%
.

The baseline characteristics of TALA or PCT treatment in patients with a history of central nervous system metastasis are comparable
.
The baseline characteristics of TALA or PCT treatment in patients with a history of central nervous system metastasis are comparable
.

The treatment options for patients with a history of central nervous system metastasis are limited, and further exploration is needed in larger data sets
.

Source: Jennifer Keating Litton et al.

J Clin Oncol 39, 2021 (suppl 15; abstr 1090)

 

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