Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma

Kaley, Thomas; Wen, Patrick Y.; Schiff, David; Ligon, Keith L.; Haidar, Sam; Karimi, Sasan; Lassman, Andrew B.; Nolan, Craig; DeAngelis, Lisa M.; Gavrilovic, Igor T.; Norden, Andrew D.; Drappatz, Jan; Lee, Eudocia Quant; Purow, Benjamin; Plotkin, Scott R.; Batchelor, Tracy T.; Abrey, Lauren E.; Omuro, Antonio

doi:10.1093/neuonc/nou148

Cited by 229 publications

(152 citation statements)

References 34 publications

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“…Sunitinib has a dose‐dependent effect on QTc prolongation. Subsequent trials with sunitinib with cardiac safety monitoring have reported an average incidence of QTc prolongation of any degree of 8.5% and a QTc >500 ms of 1.7% without any arrhythmia 15, 23, 28, 37…”

Section: Resultsmentioning

confidence: 99%

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Porta‐Sánchez

Gilbert

Spears

et al. 2017

JAHA

159

142

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BackgroundThe cardiovascular complications of cancer therapeutics are the focus of the burgeoning field of cardio‐oncology. A common challenge in this field is the impact of cancer drugs on cardiac repolarization (ie, QT prolongation) and the potential risk for the life‐threatening arrhythmia torsades de pointes. Although QT prolongation is not a perfect marker of arrhythmia risk, this has become a primary safety metric among oncologists. Cardiologists caring for patients receiving cancer treatment should become familiar with the drugs associated with QT prolongation, its incidence, and appropriate management strategies to provide meaningful consultation in this complex clinical scenario.Methods and ResultsIn this article, we performed a systematic review (using Preferred Reporting Items of Systematic Reviews and Meta‐Analyses (PRISMA) guidelines) of commonly used cancer drugs to determine the incidence of QT prolongation and clinically relevant arrhythmias. We calculated summary estimates of the incidence of all and clinically relevant QT prolongation as well as arrhythmias and sudden cardiac death. We then describe strategies to prevent, identify, and manage QT prolongation in patients receiving cancer therapy. We identified a total of 173 relevant publications. The weighted incidence of any corrected QT (QTc) prolongation in our systematic review in patients treated with conventional therapies (eg, anthracyclines) ranged from 0% to 22%, although QTc >500 ms, arrhythmias, or sudden cardiac death was extremely rare. The risk of QTc prolongation with targeted therapies (eg, small molecular tyrosine kinase inhibitors) ranged between 0% and 22.7% with severe prolongation (QTc >500 ms) reported in 0% to 5.2% of the patients. Arrhythmias and sudden cardiac death were rare.ConclusionsOur systematic review demonstrates that there is variability in the incidence of QTc prolongation of various cancer drugs; however, the clinical consequence, as defined by arrhythmias or sudden cardiac death, remains rare.

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Section: Resultsmentioning

confidence: 99%

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Porta‐Sánchez

Gilbert

Spears

et al. 2017

JAHA

159

142

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“…65 Sunitinib, an oral RTK inhibitor against VEGFR, PDGFR, and KIT, achieved a 6-month PFS of 42% in Grade II and III meningiomas. 39 Agents against VEGFR and VEGF, including RTK inhibitors and bevacizumab, respectively, have demonstrated 6-month PFS rates of 42%-64% against AM and MM. 39,65 This relative success must be tempered, however, by the high rate of side effects and the low median overall survival (OS) with chemotherapy for these surgery-and radiation-refractory Grade II and III meningiomas, at approximately 24 months.…”

Section: Chemotherapymentioning

confidence: 99%

“…39 Agents against VEGFR and VEGF, including RTK inhibitors and bevacizumab, respectively, have demonstrated 6-month PFS rates of 42%-64% against AM and MM. 39,65 This relative success must be tempered, however, by the high rate of side effects and the low median overall survival (OS) with chemotherapy for these surgery-and radiation-refractory Grade II and III meningiomas, at approximately 24 months. 39,55,56,65 Chemotherapy for AMs shows promise but should only be considered for select refractory tumors as salvage therapy.…”

Section: Chemotherapymentioning

confidence: 99%

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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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“…Bevacizumab oder Sunitinib [30,31]. Therapieversuche mit dem Somatostatin-RezeptorAgonisten Octreotid waren weitgehend erfolglos [32].…”

Section: In Diesem Beitrag Werden Therapiestandards Und Neue Entwicklunclassified

Chemotherapie von Hirntumoren bei Erwachsenen

Roth¹,

Weller²

2015

Nervenarzt

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The treatment of patients with brain tumors has long been the domain of neurosurgery and radiotherapy but chemotherapy is now well established as an additional treatment option for many tumor entities in neuro-oncology. This is particularly true for patients with newly diagnosed and relapsing glioblastoma and anaplastic glioma as well as the treatment of medulloblastoma and primary lymphoma of the central nervous system (CNS). In addition to purely histopathological features, treatment decisions including those for chemotherapy are now based increasingly more on molecular tumor profiling. Within the group of gliomas these markers include the methylation status of the O-6-methylguanine-DNA methyltransferase (MGMT) promoter and the 1p/19q status, which reflects the loss of genetic material on chromosome arms 1p and 19q. The presence of a 1p/19q codeletion is associated with a better prognosis and increased sensitivity to alkylating chemotherapy in patients with anaplastic gliomas.

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Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma

Abstract: Sunitinib is active in recurrent atypical/malignant meningioma patients. A randomized trial should be performed.

Cited by 229 publications

References 34 publications

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review

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

Chemotherapie von Hirntumoren bei Erwachsenen

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