Multimodal management of surgery- and radiation-refractory meningiomas: an analysis of the French national tumor board meeting on meningiomas cohort

Van, Tuan Le; Graillon, Thomas; Jacob, J.; Vauléon, Élodie; Feuvret, L.; Boch, Anne‐Laure; Boetto, Julien; Boone, Mathieu; Bronnimann, Charlotte; Caire, François; Barros, Amaury De; Delaitre, Mariette; Doré, M.; Ducray, François; Dufour, Christelle; Engelhardt, Julien; Fontaine, Denys; Froelich, Sébastien; Helleringer, Matthieu; Huchet, A.; Joncour, A.; Jouanneau, Emmanuel; Mallereau, Charles-Henry; Monfilliette, Apolline; Fur, E. Le; Zemmoura, Ilyess; Chinot, Olivier; Sanson, Marc; Kalamaridès, Michel; Loiseau, Hugues; Peyre, Matthieu

doi:10.1007/s11060-021-03741-7

Cited by 12 publications

(10 citation statements)

References 30 publications

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“…Drugs directly and indirectly targeting this pathway include bevacizumab (targeted inhibition of VEGF-A), vatalanib (VEGF/PDGF receptor inhibition), and sunitinib (non-specific tyrosine kinase inhibitor) ( 48 , 95 ). Of these agents, bevacizumab is the best studied, with reported median PFS ranging from 6 to 15 months across several retrospective and prospective phase 2 studies ( 94 , 99 – 101 ). As summarized by Graillon et al.…”

Section: Clinical Managementmentioning

confidence: 99%

Identification and Management of Aggressive Meningiomas

et al. 2022

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Meningiomas are common primary central nervous system tumors derived from the meninges, with management most frequently entailing serial monitoring or a combination of surgery and/or radiation therapy. Although often considered benign lesions, meningiomas can not only be surgically inaccessible but also exhibit aggressive growth and recurrence. In such cases, adjuvant radiation and systemic therapy may be required for tumor control. In this review, we briefly describe the current WHO grading scale for meningioma and provide demonstrative cases of treatment-resistant meningiomas. We also summarize frequently observed molecular abnormalities and their correlation with intracranial location and recurrence rate. We then describe how genetic and epigenetic features might supplement or even replace histopathologic features for improved identification of aggressive lesions. Finally, we describe the role of surgery, radiotherapy, and ongoing systemic therapy as well as precision medicine clinical trials for the treatment of recurrent meningioma.

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Section: Clinical Managementmentioning

confidence: 99%

Identification and Management of Aggressive Meningiomas

et al. 2022

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“…Currently, the most common strategies used to treat aggressive, multi-recurrent meningiomas are the anti-VEGF, bevacizumab, and the combination of the SSTR2A inhibitor octreotide with everolimus [ 24 ]. Nevertheless, objective decreases in tumor mass are rare, a decrease in tumor growth rate or tumor stabilization are more frequent.…”

Section: Discussionmentioning

confidence: 99%

Co-Targeting MAP Kinase and Pi3K-Akt-mTOR Pathways in Meningioma: Preclinical Study of Alpelisib and Trametinib

Mondielli

Mougel

Darriet

et al. 2022

Cancers

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Recurrent or high-grade meningiomas are an unmet medical need. Recently, we demonstrated that targeting mTOR by everolimus was relevant both in vitro and in humans. However, everolimus induces an AKT activation that may impact the anti-proliferative effect of the drug. Moreover, the MAP kinase pathway was shown to be involved in meningioma tumorigenesis. We therefore targeted both the Pi3k-AKT-mTOR and MAP kinase pathways by using combinations of the Pi3k inhibitor alpelisib and the MEK inhibitor trametinib. Our study was performed in vitro on the human meningioma cell lines and on a large series of primary cultures providing from 63 freshly operated meningiomas including 35 WHO grade 1, 23 grade 2, and five grade 3, half of which presented a NF2 genomic alteration. Alpelisib induced a higher inhibitory effect on cell viability and proliferation than everolimus in all cell lines and 32 randomly selected tumors no matter the genomic status, the histological subtype or grade. Trametinib also strongly inhibited cell proliferation and induced AKT activation. Combined treatment with alpelisib plus trametinib reversed the AKT activation induced by trametinib and induced an additive inhibitory effect irrespective of the cell lines or tumor features. Co-targeting pathways seems promising and may be considered particularly for aggressive meningioma.

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“…The literature, however, has multiple examples of the effect of multidisciplinary teams on cancer patient management. This includes national and regional TBs on diseases such as meningiomas [ 6 ], head and neck cancer [ 7 ], pancreatic diseases [ 8 ], lung and colorectal cancer [ 9 ] and pediatric cancer [ 10 ]. The common underlying theme is that TBs have the potential to induce treatment variations by changing the diagnosis or subsequent treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Preliminary experience with a new institutional tumor board dedicated to patients with neuroendocrine neoplasms

Trikalinos

Hammill²,

Liu³

et al. 2022

Abdom Radiol

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Purpose To determine the decision patterns of a neuroendocrine neoplasm (NEN) tumor board (TB) and the factors behind those. Methods We retrospectively reviewed all NEN-TB recommendations from 07/2018 to 12/2021 and recorded patient characteristics, TB outcomes and associations between them. Results A total of 652 patient entries were identified. Median age of participants was 61 years and an equal number of men and women were presented. Most patients (33.4%) had tumors originating in the small bowel with 16.8% of high grade and 25.9% of pancreatic origin. Imaging was reviewed 97.2% of the time, with most frequently reviewed modalities being PET (55.3%) and CT (44.3%). Imaging review determined that there was no disease progression 20.8% of the time and significant treatment changes were recommended in 36.1% of patients. Major pathology amendments occurred in 3.7% of cases and a clinical trial was identified in 2.6%. There was no association between patient or disease presentation with the tumor board outcomes. There was a slight decrease in number of patients discussed per session, from 10.0 to 8.2 ( p < 0.001) when the TB transitioned to a virtual format during the COVID-19 pandemic but all other factors remained unchanged. Conclusion NEN-TB relies heavily on image review, can impact significant treatment changes in patients with rare tumors like NENs, and was not affected by the switch to a virtual format. Finally, none of the examined factors were predictive of the tumor board recommendations.

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Multimodal management of surgery- and radiation-refractory meningiomas: an analysis of the French national tumor board meeting on meningiomas cohort

Cited by 12 publications

References 30 publications

Identification and Management of Aggressive Meningiomas

Identification and Management of Aggressive Meningiomas

Co-Targeting MAP Kinase and Pi3K-Akt-mTOR Pathways in Meningioma: Preclinical Study of Alpelisib and Trametinib

Preliminary experience with a new institutional tumor board dedicated to patients with neuroendocrine neoplasms

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