Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review

Kaley, Thomas; Barani, Igor J.; Chamberlain, Marc C.; McDermott, Michael; Panageas, Katherine S.; Raizer, Jeffrey J.; Rogers, Leland; Schiff, David; Vogelbaum, Michael A.; Weber, Damien Charles; Wen, Patrick Y.

doi:10.1093/neuonc/not330

Cited by 222 publications

(177 citation statements)

References 47 publications

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“…Recurrence rates are substantially higher if only subtotal surgical removal could be achieved; in these cases a course of adjuvant radiation therapy to lower probability of recurrence or, alternatively, close imaging follow-up to pick up recurrence early should be considered (20). An ideal imaging modality to guide meningioma management should therefore be as accurate as possible to delineate tumor from tumor-free tissue in order to achieve the maximal safe resection and to detect remaining or recurrent tumor tissue as reliably as possible.…”

Section: Discussionmentioning

confidence: 99%

Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

Rachinger¹,

Stoecklein²,

Terpolilli³

et al. 2015

J Nucl Med

155

145

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Meningiomas are known to express somatostatin receptor 2 (SSTR2). PET using the SSTR2 analog 68 Ga-DOTATATE has recently been introduced for imaging of meningiomas. However, a systematic correlation between 68 Ga-DOTATATE uptake, SSTR2 expression, and histology (including tumor-free scar tissue) is still lacking. For elucidation, we conducted this prospective study. Methods: Twenty-one adult patients with primary (n 5 12) or recurrent (n 5 9) meningiomas were prospectively enrolled. Preoperative MR imaging and 68 Ga-DOTATATE PET scans were fused and used for a spatially precise neuronavigated tissue-sampling procedure during tumor resection. Histopathologic diagnosis included immunohistochemical determination of SSTR2 expression. At each individual sampling site, the maximum standardized uptake value (SUV max ) of 68 Ga-DOTATATE was correlated with MR imaging findings, histology, and semiquantitative SSTR2 expression. Results: One hundred fifteen samples (81 tumor, 34 tumor-free) were obtained. There was a significant positive correlation between SUV max and SSTR2 expression. Receiver-operating characteristic analysis revealed a threshold of 2.3 for SUV max to discriminate between tumor and nontumoral tissue. Regarding the detection of tumor tissue, PET imaging showed a higher sensitivity (90% vs. 79%; P 5 0.049), with specificity and positive predictive values similar to MR imaging, for both de novo and recurrent tumors. Conclusion: 68 Ga-DOTATATE uptake correlates with SSTR2 expression and offers high diagnostic accuracy to delineate meningioma from tumor-free tissue even in recurrent tumors after previous therapy. Our findings substantiate an important role for 68 Ga-DOTATATE PET in meningioma management.

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Section: Discussionmentioning

confidence: 99%

Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

Rachinger¹,

Stoecklein²,

Terpolilli³

et al. 2015

J Nucl Med

155

145

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“…As a whole, chemotherapy for AMs has had limited success. In a recent review of surgery-and radiation-refractory AMs and MMs treated with medical therapies, the weighted average PFS at 6 months was 26% (95% CI 19.3%-32.7%); 38 stratification by Grade II versus III was not available because most studies pooled AMs and MMs together. Pa-tients with these refractory tumors typically have a median overall survival of only 6-33 months.…”

Section: Chemotherapymentioning

confidence: 99%

“…Pa-tients with these refractory tumors typically have a median overall survival of only 6-33 months. 9,38,56 Modern trials have looked at the possible utility of receptor tyrosine kinase (RTK) inhibitors. Gefitinib, erlotinib, and imatinib, which target platelet-derived growth factor receptor (PDGFR) and epidermal growth factor receptor (EGFR), respectively, have generally been ineffective for AM and MM.…”

Section: Chemotherapymentioning

confidence: 99%

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

116

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The management of WHO Grade II “atypical” meningiomas (AMs) and Grade III “malignant” meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.

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“…A variety of cytotoxic chemotherapy agents and targeted molecular therapies have been tried without evidence of efficacy. [2][3][4] The failure to find effective targeted agents is disappointing in light of major recent advances in understanding the biology and molecular pathogenesis of meningiomas. 5,6 In a recent study of the platelet-derived growth factor receptor inhibitor imatinib for recurrent meningiomas, overall median progression-free survival (PFS) was only 2 months, and 6-month PFS (PFS6) was 29%.…”

mentioning

confidence: 99%

Phase II study of monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma

et al. 2015

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Objective: A subset of meningiomas recur after surgery and radiation therapy, but no medical therapy for recurrent meningioma has proven effective.Methods: Pasireotide LAR is a long-acting somatostatin analog that may inhibit meningioma growth. This was a phase II trial in patients with histologically confirmed recurrent or progressive meningioma designed to evaluate whether pasireotide LAR prolongs progression-free survival at 6 months (PFS6 Results: Eighteen patients were accrued in cohort A and 16 in cohort B. Cohort A had median age 59 years, median Karnofsky performance status 80, 17 (94%) had previous radiation therapy, and 11 (61%) showed high octreotide uptake. Cohort B had median age 52 years, median Karnofsky performance status 90, 11 (69%) had previous radiation therapy, and 12 (75%) showed high octreotide uptake. There were no radiographic responses to pasireotide LAR therapy in either cohort. Twelve patients (67%) in cohort A and 13 (81%) in cohort B achieved stable disease. In cohort A, PFS6 was 17% and median PFS 15 weeks (95% confidence interval: 8-20). In cohort B, PFS6 was 50% and median PFS 26 weeks (12-43). Treatment was well tolerated. Octreotide uptake and insulin-like growth factor-1 levels did not predict outcome. Expression of somatostatin receptor 3 predicted favorable PFS and overall survival. Conclusions:Pasireotide LAR has limited activity in recurrent meningiomas. The finding that somatostatin receptor 3 is associated with favorable outcomes warrants further investigation. Classification of evidence:This study provides Class IV evidence that in patients with recurrent or progressive meningioma, pasireotide LAR does not significantly increase the proportion of patients with PFS at 6 months. Neurology ® 2015;84:280-286 GLOSSARY CI 5 confidence interval; IGF-1 5 insulin-like growth factor-1; OS 5 overall survival; PFS 5 progression-free survival; PFS6 5 progression-free survival at 6 months; RANO 5 Response Assessment in Neuro-Oncology; SSTR 5 somatostatin receptor; WHO 5 World Health Organization.Meningiomas are the most common type of benign primary brain tumors in adults.1 Surgical resection is the treatment of choice, and gross total resection is predictive of long-term disease-free survival. Atypical (World Health Organization [WHO] grade 2) and malignant meningiomas (WHO grade 3) confer low rates of long-term survival, especially when gross total resection is not achieved. The typical treatment approach for recurrent disease includes reoperation, frequently accompanied by radiation therapy or stereotactic radiosurgery. These interventions delay a subsequent recurrence but rarely prevent it entirely. When surgery and radiation therapy are no longer

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Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review

Cited by 222 publications

References 47 publications

Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Phase II study of monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma

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Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review

Cited by 222 publications

References 47 publications

Increased 68Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

Increased 68Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Phase II study of monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma

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Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue

Increased ⁶⁸Ga-DOTATATE Uptake in PET Imaging Discriminates Meningioma and Tumor-Free Tissue