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cns cancers

Study Investigates Potential Embryonic Origin of Medulloblastomas

Medulloblastomas may exist in a premalignant form at birth after initially developing during the first or second trimester of pregnancy, according to a new international study published by Hendrikse et al in Nature. As medulloblastomas typically present around age 7, the team’s discovery is the...

cns cancers
genomics/genetics

Researchers Identify Potential Biomarker to Distinguish Group 3 and Group 4 Medulloblastomas

It may soon be possible to identify group 4 medulloblastomas from more aggressive group 3 tumors. Research based on a little-explored part of RNA that creates proteins may lead to the development of better-targeted therapies, according to investigators at the Johns Hopkins Kimmel Cancer Center....

lung cancer

Selpercatinib in RET Fusion–Positive Advanced NSCLC

As reported in the Journal of Clinical Oncology by Alexander Drilon, MD, and colleagues, an updated analysis of the multicohort phase I/II LIBRETTO-001 trial confirmed the activity of selpercatinib in patients with RET fusion–positive advanced non–small cell lung cancer (NSCLC). The trial supported ...

immunotherapy
symptom management

Association of Neurofilament Light Chain Levels With ICANS Risk After CAR T-Cell Therapy

In a retrospective study reported in JAMA Oncology, Butt et al found significantly higher pretreatment neurofilament light chain levels in patients who did vs did not develop immune effector cell–associated neurotoxicity syndrome (ICANS) after CD19 chimeric antigen receptor (CAR) T-cell therapy....

issues in oncology

How EQRx Aims to Reengineer the Health-Care System to Produce More Effective, Less Costly Cancer Drugs

The numbers are dizzying. The costs of cancer care in the United States are rising so fast that by 2030, it is projected the national cancer-attributable costs will total more than $246 billion, up from $183 billion in 2015—a 34% increase.1 And although the total global economic burden of cancer is ...

cns cancers
genomics/genetics

ASTRO Issues Clinical Guideline on Radiation Therapy for IDH-Mutant Glioma

A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides recommendations on the use of radiation therapy to treat patients with isocitrate dehydrogenase (IDH)-mutant grade 2 and grade 3 diffuse glioma. Evidence-based recommendations outline the multidisciplinary...

skin cancer

Atezolizumab Plus Vemurafenib/Cobimetinib for Patients With BRAF V600–Mutated Melanoma and CNS Metastases

In the phase II TRICOTEL study reported in The Lancet Oncology, Reinhard Dummer, MD, and colleagues found that the combination of atezolizumab plus vemurafenib and cobimetinib produced durable intracranial responses in patients with BRAF V600–mutated melanoma and central nervous system (CNS)...

breast cancer
immunotherapy

T-DXd Shows High Intracranial Response Rate in Patients With Active Brain Metastases From HER2-Positive Breast Cancer

In the investigator-initiated, prospective, open-label, single-arm phase II TUXEDO-1 study conducted among patients with newly diagnosed or progressive brain metastases from HER2-positive breast cancer, the antibody-drug conjugate fam-trastuzumab deruxtecan-nxki (T-DXd) yielded responses according...

cns cancers

Outcomes With Postconsolidation Dinutuximab-Based Immunotherapy for Neuroblastoma

In an analysis reported in the Journal of Clinical Oncology, Desai et al described outcomes with postconsolidation dinutuximab-based immunotherapy for high-risk neuroblastoma in a cohort of patients from the Children’s Oncology Group ANBL0032 trial following cessation of randomized treatment. Study ...

solid tumors

Proton Craniospinal Irradiation vs Photon Involved-Field Radiotherapy for Solid Tumor Leptomeningeal Metastasis

In an interim analysis of a single-institution phase II trial reported in the Journal of Clinical Oncology, Yang et al found that proton craniospinal irradiation (pCSI) improved central nervous system (CNS) progression-free survival vs standard-of-care photon involved-field radiotherapy (IFRT) in...

lymphoma

Consolidation Radiotherapy vs Autologous Stem Cell Transplantation for Primary CNS Lymphoma

As reported in the Journal of Clinical Oncology by Houillier et al, 8-year follow-up in the French phase II PRECIS trial has shown a maintained event-free survival benefit with autologous stem cell transplantation (ASCT) vs whole-brain radiotherapy (WBRT) as consolidation in patients aged ≤ 60...

cns cancers
genomics/genetics

Investigational Blood Test May Help Improve Diagnosis and Monitoring of Glioma

Researchers at Massachusetts General Hospital (MGH) who previously developed a blood test for mutations in a gene linked to gliomas have now applied their technology to detect additional mutations—in this case, in the gene that codes for the epidermal growth factor receptor (EGFR). The advance,...

cns cancers

COG Trial of Intensive Multimodality Therapy for Extraocular Retinoblastoma

As reported in the Journal of Clinical Oncology by Dunkel et al, the Children’s Oncology Group (COG) ARET0321 trial has shown high 1-year event-free survival rates with intensive multimodality therapy in patients with stage II, III, and IVa extraocular retinoblastoma. Study Details In the...

breast cancer

HER2-Positive Residual Disease

This is Part 4 of Updates in HER2-Positive Breast Cancer, a four-part video roundtable series. Scroll down to watch the other videos from this Roundtable.   In this video, Drs. Carey K. Anders, Erika Hamilton, and Sara A. Hurvitz discuss the management of HER2-positive residual disease. The patient ...

cns cancers
genomics/genetics

Deciphering the Elusive Origin and Pathways of Brain Metastases

The effective treatment of patients with brain metastases is an unmet need because, until fairly recently, patients with brain metastases were excluded from clinical trials of systemic therapies. However, the emergence of molecular targeted therapies has allowed a new treatment approach in patients ...

cns cancers

New Antibody Therapy Shows Activity in Patients With Medulloblastoma

Effective and safe treatments are needed for medulloblastoma—the most common type of cancerous brain tumor in children—especially for patients whose cancer has spread to the spinal cord. A recent phase I clinical trial has generated promising results for a new blocking antibody therapy that targets ...

lung cancer

CLN-081 Shows Selective Activity in NSCLC With EGFR Exon 20 Insertions

CLN-081, a novel agent targeted to non–small cell lung cancer (NSCLC) cells harboring epidermal growth factor receptor (EGFR) exon 20 insertion mutations—ie, the addition of nucleotide base pairs in exon 20 of the EGFR gene, a known oncogenic driver event—holds promise, according to the results of...

cns cancers

Oncolytic Virus DNX-2401 for Newly Diagnosed Pediatric Patients With Diffuse Intrinsic Pontine Glioma

In a Spanish single-institution study reported in The New England Journal of Medicine, Pérez‑Larraya et al found that intratumoral infusion of the oncolytic adenovirus DNX-2401 followed by radiotherapy showed activity in newly diagnosed pediatric patients with diffuse intrinsic pontine glioma...

cns cancers

First-Line Radiotherapy With or Without Procarbazine, Lomustine, and Vincristine Chemotherapy for Anaplastic Oligodendroglial Tumors

As reported in the Journal of Clinical Oncology by Lassman et al, final survival reports from long-term follow-up of the phase III EORTC 26951 and RTOG 9402 studies show continued benefit of the addition of (neo)adjuvant procarbazine, lomustine, and vincristine to radiotherapy in patients with...

breast cancer

Strides Are Being Made in the Treatment of Brain Metastases From Breast Cancer

New drugs for HER2-positive breast cancer are able to overcome some of the obstacles that have made brain metastases challenging to treat, according to Mark Pegram, MD, the Susy Yuan-Huey Hung Professor of Oncology at Stanford University School of Medicine in California, who described the promising ...

cns cancers
genomics/genetics

Dual-Targeted Therapy Improves Outcomes vs Chemotherapy for Some Pediatric Patients With Low-Grade Glioma

The all-oral combination of dabrafenib plus trametinib—two targeted therapies—significantly improved the overall response rate vs standard-of-care chemotherapy with carboplatin plus vincristine in pediatric patients with BRAF V600 mutation–positive low-grade gliomas. The clinical benefit rate...

lung cancer

Intracranial Efficacy of Lorlatinib vs Crizotinib in ALK-Positive Advanced NSCLC

In a post hoc analysis from the phase III CROWN trial reported in the Journal of Clinical Oncology, Benjamin J. Solomon, MBBS, PhD, and colleagues found that progression-free survival and the risk of central nervous system (CNS) progression were improved with lorlatinib vs crizotinib in previously...

breast cancer
immunotherapy

DESTINY-Breast03: Should Trastuzumab Deruxtecan Be the Preferred Second-Line Regimen in HER2-Positive Metastatic Breast Cancer?

Since the introduction of trastuzumab in the late 1990s, overall survival for patients with HER2-positive metastatic breast cancer has substantially improved. Median overall survival in the pivotal first-line trial was only 20.3 months in the chemotherapy arm, and 25.1 months in the...

cns cancers
immunotherapy

Immunotherapy Combination in Newly Diagnosed Glioblastoma

A novel combination of two experimental cancer immunotherapy agents along with an immune checkpoint blocker elicited robust immune responses in patients with newly diagnosed glioblastoma brain tumors, according to a presentation of interim, 2-year follow-up clinical trial data given by David...

cns cancers

Dabrafenib Plus Trametinib Improve Overall Response Rates vs Standard-of-Care Chemotherapy in Pediatric Patients With Low-Grade Gliomas

The combination of two targeted therapies, the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib, significantly increased the overall response rate compared to the standard-of-care chemotherapy combination of carboplatin plus vincristine in pediatric patients with BRAF V600...

breast cancer

Etirinotecan Pegol vs Physician’s Choice of Chemotherapy for Patients With Metastatic Breast Cancer and Brain Metastases

As reported in JAMA Oncology by Debu Tripathy, MD, and colleagues, the phase III ATTAIN trial has shown no difference in overall survival with etirinotecan pegol vs physician’s choice of chemotherapy for patients with metastatic breast cancer and brain metastases. As noted by the investigators,...

cns cancers

Neurologic and Survival Outcomes After Awake Craniotomy for Glioblastoma

In an analysis from the GLIOMAP study reported in The Lancet Oncology, Gerritsen et al found that awake craniotomy for glioblastoma in eloquent brain areas (essential areas for carrying out basic neurological functions) was associated with reduced risk of neurologic deficits and improved survival...

cns cancers

ASTRO Issues Clinical Guideline on Radiation Therapy for Brain Metastases

A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides guidance on the use of radiation therapy to treat patients with brain metastases. Evidence-based recommendations guide the multidisciplinary planning and delivery of advanced radiation therapy techniques to...

lung cancer
genomics/genetics
immunotherapy

DESTINY-Lung01: Is Trastuzumab Deruxtecan the Answer for HER2-Mutant Lung Cancer?

The human epidermal growth factor (HER) family of receptors are a well-established therapeutic target. Indeed, seminal studies conducted nearly 2 decades ago identified a key association between activating mutations in the kinase domain of the epidermal growth factor receptor (EGFR, also known as...

issues in oncology
genomics/genetics

Priscilla K. Brastianos, MD, on CNS Metastases: Understanding Their Evolution and the Clinical Implications

Priscilla K. Brastianos, MD, of Harvard Medical School and Massachusetts General Hospital, talks about her efforts to better understand how brain metastases evolve genomically and to test such agents as abemaciclib, paxalisib, and entrectinib, which may stop their growth. Palbociclib, a CDK...

issues in oncology

Phase III Trials and Tribulations

Imagine this. You are a large pharmaceutical company that launches an international randomized phase III trial to assess whether one of your drugs improves the outcome of patients with a common type of cancer. The trial was solidly backed by preclinical evidence that the drug target was essential ...

lymphoma

Mihir Gupta, MD, and Ganesh M. Shankar, MD, PhD, Offer Commentary on the Use of ctDNA to Detect CNS Lymphoma

Mihir Gupta, MD, a neurosurgery resident at the University of California San Diego and postdoctoral fellow at Massachusetts General Hospital Department of Neurosurgery, and Ganesh M. Shankar, MD, PhD, Assistant Professor of Neuro­surgery, Massachusetts General Hospital and Harvard Medical School,...

lymphoma

Noninvasive Diagnosis of CNS Lymphoma Possible Through ctDNA

Circulating tumor DNA (ctDNA) is readily detectable in the plasma and cerebrospinal fluid of patients with central nervous system (CNS) lymphoma and is a strong prognostic biomarker for outcomes, a team of researchers from Germany and Stanford University reported at the 2021 American Society of...

hematologic malignancies
lymphoma

CAR T-Cell Therapy as Second-Line Treatment in Large B-Cell Lymphomas

“The mind is not a vessel to be filled but a fire to be kindled.”                                                                                    —Plutarch About 30% to 40% of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) experience relapse, and 10% are refractory to the...

solid tumors

New Guideline Offers Most Comprehensive Summary to Date of Therapies for Brain Metastases

In an effort to synthesize findings from multiple guidelines on various management approaches for brain metastases, ASCO, the Society for Neuro-Oncology (SNO), and the American Society for Radiation Oncology (ASTRO) spearheaded the development of a novel publication to inform and update physician...

lung cancer
immunotherapy

T-DXd for Previously Treated Patients With Metastatic HER2-Mutant NSCLC

In the phase II DESTINY-Lung01 trial reported in The New England Journal of Medicine, Bob T. Li, MD, PhD, MPH, and colleagues found that fam-trastuzumab deruxtecan-nxki (T-DXd) showed durable activity in patients with metastatic HER2-mutant non–small cell lung cancer (NSCLC) refractory to standard...

cns cancers

Is There an Association Between Maternal Hormonal Contraception Use and Risk of CNS Tumors in Children?

In a Danish nationwide cohort study reported in JAMA, Hargreave et al found no association between maternal hormonal contraception use and risk of central nervous system (CNS) tumors in children. As stated by the investigators, “The incidence of CNS tumors in children appears to be increasing, yet...

cns cancers
supportive care
symptom management

Does Armodafinil Improve Cancer-Related Fatigue in Patients With High-Grade Glioma?

In a phase III trial reported in JAMA Oncology, Porter et al found that armodafinil, a psychostimulant, did not improve cancer-related fatigue vs placebo in adult patients with high-grade glioma. As stated by the investigators, “Nearly 96% of patients with high-grade glioma report...

cns cancers
genomics/genetics

Dabrafenib Plus Trametinib in BRAF V600E–Mutant High- and Low-Grade Glioma

In an interim analysis of a phase II basket trial (ROAR) reported in The Lancet Oncology, Patrick Y. Wen, MD, and colleagues found that the combination of dabrafenib and trametinib produced responses in adult patients with recurrent or progressive BRAF V600E–mutant high-grade and low-grade glioma. ...

lung cancer

T-DXd Makes Inroads in the Treatment of HER2-Mutant NSCLC

Previously treated patients with HER2-positive non–small cell lung cancer (NSCLC) achieved encouraging response rates and duration of response to the antibody-drug conjugate fam-trastuzumab deruxtecan-nxki (T-DXd) in the phase II DESTINY-Lung01 trial. These results were reported at the European...

cns cancers

Brain Substructure–Informed Radiotherapy Planning May Improve Neurocognitive Outcomes in Pediatric Patients With Medulloblastoma

In an analysis from the single-institution phase III SJMB03 trial reported in the Journal of Clinical Oncology, Acharya et al found that increasing radiation doses to the corpus callosum, frontal white matter, and hippocampus were associated with neurocognitive impairment in pediatric patients...

cns cancers

Erin Murphy, MD, on Low-Grade Glioma: Neurocognitive Function Following Treatment

Erin Murphy, MD, of Cleveland Clinic, discusses new data that show no apparent difference in cognitive performance up to 2 years post-treatment among adults with low-grade glioma who were treated with concurrent radiotherapy and temozolomide (Abstract 3258).

cns cancers

Integrated Molecular-Morphologic Risk Predictor for Recurrence of Meningioma

In a study reported in the Journal of Clinical Oncology, Maas et al developed a novel integrated molecular-morphologic risk classification score that improved prediction of disease recurrence in patients with meningioma. Study Details The study involved DNA methylation, copy-number, and mutation...

cns cancers
genomics/genetics

Diana D. Shi, MD, on IDH-Mutant Gliomas: De Novo Pyrmidine Synthesis Inhibitor Under Study

Diana D. Shi, MD, of Dana-Farber Cancer Institute and Brigham and Women’s Cancer Center, discusses studies being planned and already underway to test BAY 2402234, a de novo pyrimidine synthesis inhibitor that possibly could be used clinically to target IDH-mutant gliomas and may act as a...

cns cancers
immunotherapy

Two Studies Examine the Efficacy of Immunotherapy for Leptomeningeal Carcinomatosis

Two new studies published in Nature Communications indicate that immunotherapy may benefit people with leptomeningeal carcinomatosis, a rare but serious complication of cancer that has spread to the brain and/or spinal cord.  Approximately 5% to 8% of all patients with cancer develop leptomeningeal ...

cns cancers

DM-CHOC-PEN May Improve Outcomes for Adolescents and Young Adults With Central Nervous System Tumors

In a phase II clinical trial, the drug 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) improved survival for some adolescent and young adult patients with cancers involving the central nervous system, according to results presented by Morgan et al at the AACR-NCI-EORTC Virtual...

breast cancer

Novel HER2-Targeted Therapies Pose Sequencing Challenges

With three new HER2-targeted therapies approved over the past year or two alone, the treatment landscape for patients with metastatic breast cancer has become increasingly crowded. In the third-line setting and beyond, there are now at least eight HER2-targeted agents approved by the U.S. Food and...

head and neck cancer
cns cancers

Factors Associated With Risk of Hearing Loss in Pediatric Patients Receiving Radiation and Chemotherapy

In a single-institution cohort study reported in the Journal of Clinical Oncology, Keilty et al identified factors associated with an increased risk of hearing loss in pediatric patients receiving radiation therapy and chemotherapy for central nervous system and head and neck tumors. The study...

lymphoma

DA-EPOCH-R for Children and Adolescents With Newly Diagnosed Primary Mediastinal B-Cell Lymphoma

In a phase II trial reported in the Journal of Clinical Oncology, Burke et al found that dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone plus rituximab (DA-EPOCH-R) did not improve event-free survival vs historical controls in children and adolescents with ...

lymphoma
geriatric oncology

Older Adults With Primary CNS Lymphoma: Treatment Opportunities and Challenges

The ASCO Post is pleased to present the Hematology Expert Review, an ongoing feature that quizzes readers on issues in hematology. In this installment, Drs. Abutalib, Desai, and DeAngelis explore the treatment of older patients with primary central nervous system lymphoma (PCNSL), which pose...

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