Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

Mapelli, Roberto; Julita, Chiara; Bianchi, S; Gallina, Nicolò; Lucchini, R.; Midulla, M.; Puci, Flavia; Saddi, Jessica; Trivellato, S.; Panizza, D.; Ponti, Elena De; Arcangeli, Stefano

doi:10.1007/s00066-021-01855-5

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…Especially in combination with systemic chemotherapy like 5‑FU [ 50 ] or the PCV scheme [ 51 ], the use of iv radiosensitization with halogenated pyrimidines caused increased amounts of grade III and IV toxicity, last-mentioned in a large phase III trial (RTOG 9404) on patients with anaplastic astrocytoma in 2004, which also concluded a lack of survival benefit [ 52 ]. With emerging relevance of combination treatment of RT and temozolomide or nitrosoureas (both also having accompanying potential for myelosuppression and lymphopenia, a side effect with unclear relevance concerning treatment outcome [ 53 ]), the use of halogenated pyrimidines as radiosensitizers for glioma treatment did not prove to be profitable enough and was abandoned. Table 7 summarizes the published trials evaluating halogenated pyrimidines as radiosensitizers.…”

Section: Resultsmentioning

confidence: 99%

The use of radiosensitizing agents in the therapy of glioblastoma multiforme—a comprehensive review

2022

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Background Glioblastoma is the most common malignant brain tumor in human adults. Despite several improvements in resective as well as adjuvant therapy over the last decades, its overall prognosis remains poor. As a means of improving patient outcome, the possibility of enhancing radiation response by using radiosensitizing agents has been tested in an array of studies. Methods A comprehensive review of clinical trials involving radiation therapy in combination with radiosensitizing agents on patients diagnosed with glioblastoma was performed in the National Center for Biotechnology Information’s PubMed database. Results A total of 96 papers addressing this matter were published between 1976 and 2021, of which 63 matched the subject of this paper. All papers were reviewed, and their findings discussed in the context of their underlining mechanisms of radiosensitization. Conclusion In the history of glioblastoma treatment, several approaches of optimizing radiation-effectiveness using radiosensitizers have been made. Even though several different strategies and agents have been explored, clear evidence of improved patient outcome is still missing. Tissue-selectiveness and penetration of the blood–brain barrier seem to be major roadblocks; nevertheless, modern strategies try to circumvent these obstacles, using novel sensitizers based on preclinical data or alternative ways of delivery.

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Section: Resultsmentioning

confidence: 99%

The use of radiosensitizing agents in the therapy of glioblastoma multiforme—a comprehensive review

2022

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“…This may partially explain the T cell lymphopenia in glioblastoma patients. However, treatment (radiation and TMZ) associated T cell lymphopenia was also very common [ 83 , 84 ] .…”

Section: Drug Resistance To Immunotherapy In Glioblastomamentioning

confidence: 99%

Drug resistance in glioblastoma: from chemo- to immunotherapy

Sharma,

Chepurna,

Sun

2023

Cancer Drug Resist

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As the most common and aggressive type of primary brain tumor in adults, glioblastoma is estimated to end over 10,000 lives each year in the United States alone. Stand treatment for glioblastoma, including surgery followed by radiotherapy and chemotherapy (i.e., Temozolomide), has been largely unchanged since early 2000. Cancer immunotherapy has significantly shifted the paradigm of cancer management in the past decade with various degrees of success in treating many hematopoietic cancers and some solid tumors, such as melanoma and non-small cell lung cancer (NSCLC). However, little progress has been made in the field of neuro-oncology, especially in the application of immunotherapy to glioblastoma treatment. In this review, we attempted to summarize the common drug resistance mechanisms in glioblastoma from Temozolomide to immunotherapy. Our intent is not to repeat the well-known difficulty in the area of neuro-oncology, such as the blood-brain barrier, but to provide some fresh insights into the molecular mechanisms responsible for resistance by summarizing some of the most recent literature. Through this review, we also hope to share some new ideas for improving the immunotherapy outcome of glioblastoma treatment.

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Sarcopenia is associated with chemoradiotherapy discontinuation and reduced progression-free survival in glioblastoma patients

Troschel,

Kloss

et al. 2024

Strahlenther Onkol

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Purpose Sarcopenia may complicate treatment in cancer patients. Herein, we assessed whether sarcopenia measurements derived from radiation planning computed tomography (CT) were associated with complications and tumor progression during radiochemotherapy for glioblastoma. Methods Consecutive patients undergoing radiotherapy planning for glioblastoma between 2010 and 2021 were analyzed. Retrocervical muscle cross-sectional area (CSA) was measured via threshold-based semi-automated radiation planning CT analysis. Patients in the lowest sex-specific quartile of muscle measurements were defined as sarcopenic. We abstracted treatment characteristics and tumor progression from the medical records and performed uni- and multivariable time-to-event analyses. Results We included 363 patients in our cohort (41.6% female, median age 63 years, median time to progression 7.7 months). Sarcopenic patients were less likely to receive chemotherapy (p < 0.001) and more likely to be treated with hypofractionated radiotherapy (p = 0.005). Despite abbreviated treatment, they more often discontinued radiotherapy (p = 0.023) and were more frequently prescribed corticosteroids (p = 0.014). After treatment, they were more often transferred to inpatient palliative care treatment (p = 0.035). Finally, progression-free survival was substantially shorter in sarcopenic patients in univariable (median 5.1 vs. 8.4 months, p < 0.001) and multivariable modeling (hazard ratio 0.61 [confidence interval 0.46–0.81], p = 0.001). Conclusion Sarcopenia is a strong risk factor for treatment discontinuation and reduced progression-free survival in glioblastoma patients. We propose that sarcopenic patients should receive intensified supportive care during radiotherapy and during follow-up as well as expedited access to palliative care.

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Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

Cited by 7 publications

References 41 publications

The use of radiosensitizing agents in the therapy of glioblastoma multiforme—a comprehensive review

The use of radiosensitizing agents in the therapy of glioblastoma multiforme—a comprehensive review

Drug resistance in glioblastoma: from chemo- to immunotherapy

Sarcopenia is associated with chemoradiotherapy discontinuation and reduced progression-free survival in glioblastoma patients

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