Glioblastoma care in the elderly

Glioblastoma is common among elderly patients, a group in which comorbidities and a poor prognosis raise important considerations when designing neuro‐oncologic care. Although the standard of care for nonelderly patients with glioblastoma includes maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide, the safety and efficacy of these modalities in elderly patients are less certain given the population's underrepresentation in many clinical trials. The authors reviewed the clinical trial literature for reports on the treatment of elderly patients with glioblastoma to provide evidence‐based guidance for practitioners. In elderly patients with glioblastoma, there is a survival advantage for those who undergo maximal safe resection, which likely includes an incremental benefit with increasing completeness of resection. Radiotherapy extends survival in selected patients, and hypofractionation appears to be more tolerable than standard fractionation. In addition, temozolomide chemotherapy is safe and extends the survival of patients with tumors that harbor O(6)‐methylguanine‐DNA methyltransferase (MGMT) promoter methylation. The combination of standard radiation with concurrent and adjuvant temozolomide has not been studied in this population. Although many questions remain unanswered regarding the treatment of glioblastoma in elderly patients, the available evidence provides a framework on which providers may base individual treatment decisions. The importance of tumor biomarkers is increasingly apparent in elderly patients, for whom the therapeutic efficacy of any treatment must be weighed against its potential toxicity. MGMT promoter methylation status has specifically demonstrated utility in predicting the efficacy of temozolomide and should be considered in treatment decisions when possible. Cancer 2016;122:189–197. © 2015 American Cancer Society.     

SDHB mutations are associated with response to temozolomide in patients with metastatic pheochromocytoma or paraganglioma

Cyclophosphamide–dacarbazine–vincristine regimen is recommended for the treatment of malignant pheochromocytoma and paraganglioma (MPP); however, dacarbazine is the only recognized active drug in neuroendocrine tumours. We investigated the therapeutic benefit of temozolomide (TMZ), an oral alternative to dacarbazine, in patients with MPP. This is a retrospective study of consecutive patients with documented progressive MPP. We examined the correlation between Succinate dehydrogenase B (SDHB) mutation and O(6)‐methylguanine‐DNA methyltransferase (MGMT) promoter methylation and MGMT expression in the French nation‐wide independent cohort of 190 pheochromocytomas or paragangliomas (PP). Progression‐free survival (PFS) according to RECIST 1.1 and PERCIST 1.0 criteria was the primary end point. Fifteen consecutive patients with MPP were enrolled; ten (67%) carried a mutation in SDHB. The mean dose intensity of TMZ was 172 mg/m²/d for 5 days every 28 days. Median PFS was 13.3 months after a median follow‐up of 35 months. There were five partial responses (33%), seven stable (47%) and three progressive diseases (20%). Grade 3 toxicities were lymphopenia in two patients and hypertension in one. Partial responses were observed only in patients with mutation in SDHB. MGMT immunohistochemistry was negative in tumour samples from four patients who responded to treatment. SDHB germline mutation was associated with hypermethylation of the MGMT promoter and low expression of MGMT in 190 samples of the French nation‐wide independent cohort. This study demonstrates that TMZ is an effective antitumour agent in patients with SDHB‐related MPP. The silencing of MGMT expression as a consequence of MGMT promoter hypermethylation in SDHB‐mutated tumours may explain this finding.     

Combined loss of expression of O6-methylguanine-DNA methyltransferase and hMLH1 accelerates progression of hepatocellular carcinoma

BACKGROUND AND OBJECTIVES: O(6)-methylguanine-DNA methyltransferase (MGMT) and human Mut L homologue 1 (hMLH1) are proteins that play an important role in DNA repair. No reports have yet described whether deficient MGMT and hMLH1 expression correlates with tumor progression and the prognosis of patients with hepatocellular carcinoma (HCC). METHODS: Using immunohistochemical analysis, we evaluated the expression status of MGMT and hMLH1 protein in 60 paraffin-embedded samples from consecutive patients with curatively resected HCC. RESULTS: The lack of expression of both MGMT and hMLH1 in HCCs (n = 7) correlated with advanced pTNM stage (P = 0.039), as compared with HCCs expressing both proteins (n = 25). The absence of both MGMT and hMLH1 was a significant indicator of malignant potential. The expression status of both MGMT and hMLH1 was a predictive factor for overall survival in patients with HCC (P < 0.001). CONCLUSIONS: HCC lacking both MGMT and hMLH1 is correlated with an advanced stage and a poor prognosis. The expression status of both repair proteins is a predictive prognostic marker in patients with HCC after surgical resection.     

Prognostic impact of O6‐methylguanine‐DNA methyltransferase silencing in patients with recurrent glioblastoma multiforme who undergo surgery and carmustine wafer implantation

BACKGROUND:

O⁶‐methylguanine‐DNA methyltransferase (MGMT) is a key enzyme in the DNA repair process after alkylating agent action. Epigenetic silencing of the MGMT gene by promoter methylation has been associated with longer survival in patients with newly diagnosed glioblastoma multiforme (GBM) who receive alkylating agents. In this study, the authors evaluated the prognostic value of different biomarkers in recurrent GBM and analyzed the changes in MGMT status between primary tumors and recurrent tumors.

METHODS:

Twenty‐two patients who had recurrent GBM and who underwent surgery with carmustine wafer implantation were enrolled prospectively between 2005 and 2007. The authors investigated the correlation between MGMT silencing in the tumor at recurrence and survival taking into account other clinically recognized prognostic factors. MGMT status was determined by using methylation‐specific polymerase chain reaction analysis, a high‐throughput quantitative methylation assay, and immunohistochemistry. In addition, expression analyses of human mutL homolog 1, human mutS homolog 2, and tumor necrosis factor α‐induced protein 3 at recurrence were conducted with regard to their prognostic impact.

RESULTS:

The median progression‐free survival (PFS) and overall survival (OS) rates after recurrence were 3.6 months and 9.9 months, respectively, and the 6‐month PFS rate after recurrence was 27.2%. On multivariate analysis, only age (P = .04) and MGMT promoter hypermethylation at recurrence, as determined by MethyLight technology (P = .0012) and methylation‐specific polymerase chain reaction (MSP) analysis (P = .004), were correlated with better PFS. On multivariate analysis, only MGMT promoter hypermethylation at recurrence, as determined by using MethyLight technology (P = .019) and MSP analysis (P = .046), was associated with better OS.

CONCLUSIONS:

MGMT methylation status was an important prognostic factor in patients with recurrent GBM who underwent surgery plus carmustine wafer implantation; therefore, it was useful in predicting the outcome of GBM therapy at recurrence. Cancer 2009. © 2009 American Cancer Society.     

FHL2通过MGMT影响胶质母细胞瘤U87细胞对替莫唑胺的耐药性

目的：探讨干扰四个半LIM结构域蛋白2(FHL2)的表达对胶质母细胞瘤U87细胞中O⁶-甲基鸟嘌呤DNA甲基转移酶(MGMT)表达的影响,以及对U87细胞替莫唑胺(TMZ)耐药性的影响。方法：利用慢病毒感染技术分别将携带不同FHL2干扰序列的慢病毒(shFHL2-1#、shFHL2-4#)及其阴性对照(shN)感染U87细胞,分别命名为shFHL2-1#、shFHL2-4#和shN组;采用siRNA转染技术将siMGMT-1#、siMGMT-4#和siN转染至U87细胞,为siMGMT-1#、siMGMT-4#和siN组,qPCR和WB法验证FHL2或MGMT的敲低效果。用TMZ处理上述各组细胞(以DMSO处理组为对照),随后以CCK-8法和细胞克隆形成实验检测TMZ处理前后FHL2或MGMT敲低组细胞的增殖情况,FCM检测TMZ处理前后FHL2敲低组细胞的凋亡情况,WB法和免疫荧光法检测敲低FHL2对U87细胞中MGMT表达的影响,WB法检测TMZ处理对各组细胞中FHL2和MGMT表达水平的影响。结果：成功构建敲低FHL2或MGMT表达的U87细胞。与shN组相...     

O~6-甲基鸟嘌呤-DNA甲基转移酶甲基化状态和同期放化治疗与中国香港胶质母细胞瘤患者生存的相关性研究

背景与目的:胶质母细胞瘤(GBM)是一种恶性程度最高的星形细胞瘤,其主要的治疗方法是外科手术和放射疗法,2005年批准使用替莫唑胺,化学疗法的效果才得以确定。本文比较中国香港原发性GBM患者接受同期放化治疗或单纯放疗的生存时间,探讨GBM肿瘤组织中O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)的甲基化状态在预后评价的价值。方法:回顾性分析2005年3月至2007年6月期间35例经手术后病理确诊并接受过同期放化治疗或单纯放疗的中国香港GBM患者的资料,从石蜡包埋的GBM肿瘤组织中分离出基因组DNA,采用甲基化特异性聚合酶链反应方法(MSP)检测基因MGMT甲基化状态。采用Kaplan Meier方法计算总生存时间(OS)和无进展生存时间(PFS),比较同期放化治疗或单纯放疗和MGMT甲基化或非甲基化状态对生存时间的影响。结果:35例患者中,男性27例,女性8例,平均年龄50.4岁。35例患者的中位PFS和中位OS分别是4.7个月(3.1~6.2个月)和11.7个月(6.5~16.6个月),其中18例仅接受单纯放疗患者的中位PFS和中位OS分别是4.2个月(3.4~5.0个月)和5.8个月(2.0~9.6个月),17例接受同期放化治疗患者的中位PFS和中位OS分别是6.0个月(2.0~10个月)和13.2个月(8.1~18.3个月),P值>0.05。15例(43%)肿瘤组织中存在MGMT甲基化,MGMT甲基化和非甲基化患者的中位OS分别是16.9个月(12.7~21.1个月)和10个月(5.8~14.1个月),P值>0.05。结论:尽管差异无统计学意义,但与单纯放疗比较,接受了同期放化治疗的GBM患者显示出了更长的总体生存趋势,MGMT甲基化可能是GBM的明显预后较好的因素。     

Predictive impact of MGMT promoter methylation in glioblastoma of the elderly

O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter methylation identifies a subpopulation of glioblastoma patients with more favorable prognosis and predicts a benefit from alkylating agent chemotherapy (CT). Little is known about its prevalence and clinical significance in older glioblastoma patients. We studied 233 glioblastoma patients aged 70 years or more (144 males, 89 females, median age: 74 years, range: 70.0-86.6 years), who were prospectively enrolled in the German Glioma Network, for MGMT promoter methylation by methylation-specific PCR (MSP) in all patients and DNA pyrosequencing in 166 patients. MGMT data were correlated with patient outcome. Median progression-free survival (PFS) was 4.8 months (95% CI: 4.3-5.3) and median overall survival (OS) was 7.7 months (95% CI: 6.3-9.0). MGMT promoter methylation was detected by MSP in 134 patients (57.5%). For the whole cohort, PFS was 5.2 versus 4.7 months (p = 0.207) and OS was 8.4 versus 6.4 months (p = 0.031) in patients with versus without MGMT promoter methylation. Patients with MGMT methylated tumors had longer PFS when treated with radiotherapy (RT) plus CT or CT alone compared to patients treated with RT alone. Patients with MGMT unmethylated tumors appeared to derive no survival benefit from CT, regardless of whether given at diagnosis together with RT or as a salvage treatment. Patients treated with RT plus CT or CT alone demonstrated longer OS when pyrosequencing revealed >25% MGMT methylated alleles. Taken together, MGMT promoter methylation may be a useful biomarker to stratify elderly glioblastoma patients for treatment with versus without alkylating agent CT.     

High levels of phosphorylated MAP kinase are associated with poor survival among patients with glioblastoma during the temozolomide era

We investigated whether high levels of activated mitogen-activated protein kinase (p-MAPK) were associated with poor survival among patients with newly diagnosed glioblastoma during the temozolomide era. Nuclear p-MAPK expression of 108 patients with GBM was quantified and categorized in the following levels: low (0%–10%), medium (11%–40%), and high (41%–100%). Independent predictors of overall survival were determined using a multivariate Cox proportional hazards model. Our study included 108 patients with newly diagnosed GBM. Median age was 65 years, and 74% had high Karnofsky performance status (KPS ≥ 80). Median overall survival among all patients was 19.5 months. Activated MAPK expression levels of <10%, 11%–40%, and ≥41% were observed in 33 (30.6%), 37 (34.3%), and 38 (35.2%) patients, respectively. Median survival for low, medium, and high p-MAPK expression was 32.4, 18.2, and 12.5 months, respectively. Multivariate analysis showed 2.4-times hazard of death among patients with intermediate p-MAPK than low p-MAPK expression (hazard ratio [HR], 2.4; P = .02); high-expression patients were 3.9 times more likely to die, compared with patients with low p-MAPK (HR, 3.9; P = .007). Patients aged ≥65 years (HR, 2.8; P = .002) with KPS < 80 (HR, 3.1; P = .0003) and biopsy or partial resection (HR, 1.9; P = .02) had higher hazard of death. MGMT and PTEN expression were not associated with survival differences. This study provides quantitative means of evaluating p-MAPK in patients with GBM. It confirms the significant and independent prognostic relevance of p-MAPK in predicting survival of patients with GBM treated in the temozolomide era and highlights the need for therapies targeting the p-MAPK oncogenic pathway.     

Promoter methylation and expression of MGMT and the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2 in paired primary and recurrent glioblastomas

Epigenetic silencing of the O(6) -methylguanine-DNA methyltransferase (MGMT) gene promoter is associated with prolonged survival in glioblastoma patients treated with temozolomide (TMZ). We investigated whether glioblastoma recurrence is associated with changes in the promoter methylation status and the expression of MGMT and the DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2 in pairs of primary and recurrent glioblastomas of 80 patients, including 64 patients treated with radiotherapy and TMZ after the first operation. Among the primary tumors, the MGMT promoter was methylated in 31 patients and unmethylated in 49 patients. In 71 patients (89%), the MGMT promoter methylation status of the primary tumor was retained at recurrence. MGMT promoter methylation, but not MGMT protein expression, was associated with longer progression-free survival, overall survival and postrecurrence survival (PRS). Moreover, PRS was increased under salvage chemotherapy. Investigation of primary and recurrent glioblastomas of 43 patients did not identify promoter methylation in any of the four MMR genes. However, recurrent glioblastomas demonstrated significantly lower MSH2, MSH6 and PMS2 protein expression as detected by immunohistochemistry. In conclusion, reduced expression of MMR proteins, but not changes in MGMT promoter methylation, is characteristic of glioblastomas recurring after the current standards of care.     

MGMT在脑胶质瘤组织中的表达及其与患者生存期的关系

背景与目的:目前的研究已经证实DNA修复酶——6-氧-甲基鸟嘌呤DNA甲基转移酶(O6-methylguanine-DNAmethyltransferase,MGMT)在脑胶质瘤组织中的表达与肿瘤的耐药性有一定的关系,并且能够影响肿瘤的化疗效果。本研究通过分析MGMT在脑胶质瘤组织中的表达及其与患者生存期的关系,为基于耐药机制上的脑胶质瘤分子分类提供参考资料。方法:用组织芯片技术和免疫组织化学方法检测311例脑胶质瘤石蜡标本中MGMT的表达情况,并对所有患者进行手术后的5年随访。结果:MGMT表达阳性者126例,占40.51%(126/311)。其中,星形细胞瘤中阳性率为50.41%(61/121),少枝胶质细胞瘤中为25.71%(18/70),少枝星形细胞瘤中为28.13%(18/64),胶质母细胞瘤中为51.79%(29/56);在Ⅰ～Ⅱ级胶质瘤中,MGMT表达的阳性率为36.56%(68/186),而在Ⅲ～Ⅳ级胶质瘤中为46.40%(58/125),经χ2检验分析,两者之间有显著性差异(P<0.001);将MGMT的表达与患者生存期的关系绘制成Kaplan-Meier生存曲线,并进行log-rank分析,MGMT表达阳性者与阴性者之间的差异有显著性(P<0.05)。结论:MGMT在脑胶质瘤的异常表达与肿瘤的组织类型、病理级别有关,MGMT表达阳性患者的生存期明显低于表达阴性的患者。     

甲基化抗肿瘤药物治疗中的DNA修复:治疗效果与健康结局

在甲基化抗肿瘤药物治疗中,DNA修复是决定治疗效果与不良生物效应（如突变、癌变和致畸）的一个关键机制。本文主要对甲基化抗肿瘤药物在DNA修复过程的作用进行综述。尽管这些抗肿瘤药物无选择性地靶向作用于癌细胞和正常细胞的DNA,但因其削弱了癌细胞内某些特异的DNA修复活动,从而更多地杀死癌细胞。单功能的烷化剂显示出甲基化改变特性（丙卡巴肼、达卡巴嗪、链脲佐菌素、替莫唑胺）,或者氯乙基化形成单加合物并在下一步反应中引起DNA链内交联（洛莫司汀、尼莫地平、卡莫司汀、福莫司汀）。癌细胞对抗肿瘤药物的一个主要机制是通过自杀酶O⁶-甲基鸟嘌呤-DNA甲基转移酶（MGMT）直接逆转DNA损伤,形成O⁶-甲基鸟嘌呤和O⁶-氯化鸟嘌呤。由于MGMT对恶性肿瘤治疗的结局有显著影响,它被认为是一个耐药的重要标志,特别是在高级恶性胶质瘤。MGMT也被认为是甲基化抗肿瘤药物有效性的预测标志,许多临床试验正在分析MGMT抑制对治疗效果的影响。其他涉及甲基化抗肿瘤药物耐药的DNA修复因素包括错配修复、通过同源重组和DNA双链断裂（DSB）信号启动的相关修复。碱基切除修复和alkB同源蛋白（如ABH2）也可能与烷化类药物耐药有关,该现象在高表达MGMT的细胞株异常明显。对于这些机制的进一步了解,将有助于设计更为有效的治疗方案,同时减少副作用。     

20(S)‐ginsenoside‐Rg3 reverses temozolomide resistance and restrains epithelial‐mesenchymal transition progression in glioblastoma

Glioblastoma multiforme (GBM) is one of the most malignant human intracranial tumors. Temozolomide (TMZ) is the primary alkylating agent for GBM patients. However, many GBM patients are resistant to TMZ. Therefore, patients with GBM urgently need more effective therapeutic options. 20(S)‐ginsenoside‐Rg3 (20(S)‐Rg3) is a natural chemical with anti‐tumor effects, but at present there is little understanding of its functional mechanism. Several research reports have demonstrated that O⁶‐methylguanine DNA‐methyltransferase (MGMT) repairs damaged DNA and contributes to TMZ resistance in gliomas. In addition, recent studies have shown that MGMT gene expression could be regulated by the Wnt/β‐catenin pathway. However, whether 20(S)‐Rg3 inhibits MGMT expression and augments chemosensitivity to Temozolomide (TMZ) in glioma cells remains unclear. In this study, we explored the modulating effects of 20(S)‐Rg3 on MGMT. We used glioma cell lines, primary cell strain (including T98G, U118 and GBM‐XX; all of them are MGMT‐positive glioma cell lines) and xenograft glioma models to examine whether 20(S)‐Rg3 increased the sensitivity to TMZ and to reveal the underlying mechanisms. We found that the MGMT expression was effectively downregulated by 20(S)‐Rg3 via the Wnt/β‐catenin pathway in glioma cell lines, and TMZ resistance was significantly reversed by 20(S)‐Rg3. Meanwhile, 20(S)‐Rg3 shows no obvious cytotoxicity at its effective dose and is well tolerated in vivo. In addition, we found that 20(S)‐Rg3 significantly restrains the epithelial‐mesenchymal transition (EMT) progression of glioma cells. Taken together, these results indicate that 20(S)‐Rg3 may be a novel agent to use in treatment of GBM, especially in TMZ‐resistant GBM with high MGMT expression.     

Methylation pattern of the O6-methylguanine-DNA methyltransferase gene in colon during progressive colorectal tumorigenesis

O(6)-methylguanine-DNA methyltransferase (MGMT) is a DNA repair gene which is frequently methylated in colorectal cancer (CRC). However, it remains controversial whether methylation of specific CpG sequences within MGMT promoter leads to loss of its protein expression, and if MGMT methylation correlates with G to A transition mutations in KRAS. Two methylation sensitive regions (Mp and Eh region) of MGMT promoter were investigated in 593 specimens of colorectal tissue: 233 CRCs, 104 adenomatous polyps (AP), 220 normal colonic mucosa from CRC patients (N-C) and 36 normal colonic mucosa specimens obtained from subjects without colorectal neoplasia (N-N) by combined bisulfite restriction analysis (COBRA). The region-specific methylation data were compared to the MGMT protein expression, spectrum of KRAS mutations and other clinical features. Extensive (including both Mp and Eh) and partial (either Mp or Eh) MGMT methylation were found in 24.5% and 11.6% of CRCs, 3.8% and 27.9% of APs, 0.5% and 7.7% of C-Ns and 2.8% and 2.8% of N-Ns, respectively. Extensive methylation of MGMT promoter was primarily present in CRCs while partial methylation was common in APs. Extensive methylation of MGMT promoter was associated with loss/reduced protein expression (p < 0.0001), as well as with G to A mutations in KRAS (p = 0.0017). We herein provide first evidence that extensive methylation of MGMT promoter region is essential for methylation-induced silencing of this gene. Our data suggest that MGMT methylation may evolve and spread throughout the promoter in a stepwise manner as the colonic epithelial cells progress through the classical-adenoma-cancer multistep cascade.     

Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of Surveillance, Epidemiology, and End Results registries

BACKGROUND:

Survival after a glioblastoma multiforme (GBM) diagnosis remained static during the several decades before 1999. We hypothesized that the progressive increase in temozolomide use for GBM treatment that began in 1999 in the United States would be paralleled by a corresponding improvement in survival.

METHODS:

We included 19,674 GBM cases, ages 20 years or greater, diagnosed 1993 to 2007 in the population‐based Surveillance, Epidemiology, and End Results Program database. We used proportional hazards models to calculate calendar period hazard ratios (HR) and 95% confidence intervals (CI), adjusted for demographic covariates. We compared survival across periods using the Kaplan‐Meier method.

RESULTS:

Starting with cases diagnosed in 1999 to 2001, we observed a progressive decrease in HRs compared with cases diagnosed in 1993 to 1995. The multivariate‐adjusted HR for 2005 to 2007 versus 1993 to 1995 was 0.69 (95% CI, 0.65‐0.72). Age‐stratified analyses revealed that this progressive decrease occurred in all age groups except 80+ years. Two‐year survival increased from 7% among cases diagnosed in 1993 to 1995 and 1996 to 1998 to 9% among cases diagnosed in 1999 to 2001, 13% in 2002 to 2004, and 17% in 2005 to 2007. The disparity in survival between young and old patients increased in the temozolomide era, with 2‐year survival of 39% among cases diagnosed at ages 20 to 44 years and 1% among cases diagnosed at 80+ years in 2005 to 2007.

CONCLUSIONS:

We observed a modest, but meaningful, population‐based survival improvement for GBM patients in the United States. Widespread adoption of temozolomide represents the most likely explanation, although other treatment advances, such as increased extent of surgical resection, also may have played a role. Cancer 2012;. © 2011 American Cancer Society.     

A randomized phase II trial of veliparib,radiotherapy, and temozolomide in patients with unmethylated MGMT glioblastoma: the VERTU study

BackgroundTemozolomide offers minimal benefit in patients with glioblastoma with unmethylated O⁶-methylguanine-DNA methyltransferase (MGMT) promoter status, hence, the need for novel therapies. This study evaluated whether veliparib, a brain-penetrant poly(ADP-ribose) polymerase (PARP) inhibitor, acts synergistically with radiation and temozolomide.MethodsVERTU was a multicenter 2:1 randomized phase II trial in patients with newly diagnosed glioblastoma and MGMT-unmethylated promotor status. The experimental arm consisted of veliparib and radiotherapy, followed by adjuvant veliparib and temozolomide. The standard arm consisted of concurrent temozolomide and radiotherapy, followed by adjuvant temozolomide. The primary objective was to extend the progression-free survival rate at six months (PFS-6m) in the experimental arm.ResultsA total of 125 participants were enrolled, with 84 in the experimental arm and 41 in the standard arm. The median age was 61 years, 70% were male, 59% had Eastern Cooperative Oncology Group (ECOG) performance status of 0, and 87% underwent macroscopic resection. PFS-6m was 46% (95% confidence interval [CI]: 36%-57%) in the experimental arm and 31% (95% CI: 18%-46%) in the standard arm. Median overall survival was 12.7 months (95% CI: 11.4-14.5 months) in the experimental arm and 12.8 months (95% CI: 9.5-15.8 months) in the standard arm. The most common grade 3-4 adverse events were thrombocytopenia and neutropenia, with no new safety signals.ConclusionThe veliparib-containing regimen was feasible and well tolerated. However, there was insufficient evidence of clinical benefit in this population. Further information from correlative translational work and other trials of PARP inhibitors in glioblastoma are still awaited.     

Immunoexpression of p62/SQSTM1/Sequestosome-1 in human primary and recurrent IDH1/2 wild-type glioblastoma: A pilot study

p62/SQSTM1/Sequestosome-1 is an autophagic protein that serves a crucial role in cellular metabolism, proliferation and malignant growth. Notably, autophagy may influence the development and resistance to therapy of numerous types of human cancer. In the present pilot study, the immunohistochemical pattern of p62 was analyzed in a cohort of patients with isocitrate dehydrogenase (IDH)1/2 wild-type glioblastoma (GBM), in primary and recurrent samples, in order to verify the concordance or discordance between the primary and recurrent tumors. In addition, the association between p62, and patient outcome and O⁶-methylguanine-DNA methyltransferase (MGMT) status was assessed. The results revealed p62 immunoexpression in the nucleus and cytoplasm of neoplastic elements in 45% of primary and 55% of recurrent cases of GBM. A discordant p62 immunoreactivity was detected in 35% of cases, with a variation either with positive or negative conversion of p62 status. Statistically, p62 expression and MGMT status exhibited a significant prognostic value by univariate analysis, whereas only MGMT promoter methylation status emerged as an independent prognostic factor by multivariate analysis. Finally, the most favorable prognosis was documented when the same GBM case was positively concordant for both p62 expression and MGMT methylated status. Since little data are available regarding the association between p62 expression and MGMT in GBM, further investigations may be required to determine if new targeted therapies may be addressed against autophagy-related proteins, such as p62.