bims-malgli Biomed News
on Biology of malignant gliomas
Issue of 2023‒09‒24
fifteen papers selected by
Oltea Sampetrean, Keio University
  1. Glioblastoma Cell Invasion: Go? Grow? Yes.
  2. Dabrafenib-trametinib is effective in paediatric high-grade glioma.
  3. Glioma Response to IDH Inhibition: Real-World Experience.
  4. Hypoxanthine phosphoribosyl transferase 1 metabolizes temozolomide to activate AMPK for driving chemoresistance of glioblastomas.
  5. A paracrine circuit of IL-1β/IL-1R1 between myeloid and tumor cells drives genotype-dependent glioblastoma progression.
  6. A H3K27M-targeted vaccine in adults with diffuse midline glioma.
  7. A Win for Targeted Therapy in Pediatric BRAF-Mutant Gliomas.
  8. Advanced age in humans and mouse models of glioblastoma show decreased survival from extratumoral influence.
  9. NLGN4X TCR transgenic T cells to treat gliomas.
  10. Breaking barriers for glioblastoma with a path to enhanced drug delivery.
  11. Primary brain tumours in adults.
  12. Optimizing preclinical pediatric low-grade glioma models for meaningful clinical translation.
  13. Inaugural Results of the Individualized Screening Trial of Innovative Glioblastoma Therapy: A Phase II Platform Trial for Newly Diagnosed Glioblastoma Using Bayesian Adaptive Randomization.
  14. Indoximod-based chemo-immunotherapy for pediatric brain tumors: a first-in-children phase 1 trial.
  15. Dabrafenib plus Trametinib in Pediatric Glioma with BRAF V600 Mutations.
  1. Neuro Oncol. 2023 Sep 22. pii: noad178. [Epub ahead of print]
    Glioblastoma Cell Invasion: Go? Grow? Yes.
    David Odde.
      
    DOI:  https://doi.org/10.1093/neuonc/noad178
  2. Nat Rev Clin Oncol. 2023 Sep 19.
    Dabrafenib-trametinib is effective in paediatric high-grade glioma.
    Diana Romero.
      
    DOI:  https://doi.org/10.1038/s41571-023-00820-8
  3. Clin Cancer Res. 2023 Sep 22.
    Glioma Response to IDH Inhibition: Real-World Experience.
    Rimas V Lukas, Craig Horbinski.
      Treatment of IDH mutated non-enhancing grade 2 and 3 diffuse gliomas with ivosidenib leads to reduction of tumor size when assessed via volumetric MRI. IDH inhibition has a therapeutic benefit in patients with these tumors.
    DOI:  https://doi.org/10.1158/1078-0432.CCR-23-2164
  4. Nat Commun. 2023 Sep 22. 14(1): 5913
    Hypoxanthine phosphoribosyl transferase 1 metabolizes temozolomide to activate AMPK for driving chemoresistance of glioblastomas.
    Jianxing Yin, Xiefeng Wang, Xin Ge, Fangshu Ding, Zhumei Shi, Zehe Ge, Guang Huang, Ningwei Zhao, Dongyin Chen, Junxia Zhang, Sameer Agnihotri, Yuandong Cao, Jing Ji, Fan Lin, Qianghu Wang, Qigang Zhou, Xiuxing Wang, Yongping You, Zhimin Lu, Xu Qian.
      Temozolomide (TMZ) is a standard treatment for glioblastoma (GBM) patients. However, TMZ has moderate therapeutic effects due to chemoresistance of GBM cells through less clarified mechanisms. Here, we demonstrate that TMZ-derived 5-aminoimidazole-4-carboxamide (AICA) is converted to AICA ribosyl-5-phosphate (AICAR) in GBM cells. This conversion is catalyzed by hypoxanthine phosphoribosyl transferase 1 (HPRT1), which is highly expressed in human GBMs. As the bona fide activator of AMP-activated protein kinase (AMPK), TMZ-derived AICAR activates AMPK to phosphorylate threonine 52 (T52) of RRM1, the catalytic subunit of ribonucleotide reductase (RNR), leading to RNR activation and increased production of dNTPs to fuel the repairment of TMZ-induced-DNA damage. RRM1 T52A expression, genetic interruption of HPRT1-mediated AICAR production, or administration of 6-mercaptopurine (6-MP), a clinically approved inhibitor of HPRT1, blocks TMZ-induced AMPK activation and sensitizes brain tumor cells to TMZ treatment in mice. In addition, HPRT1 expression levels are positively correlated with poor prognosis in GBM patients who received TMZ treatment. These results uncover a critical bifunctional role of TMZ in GBM treatment that leads to chemoresistance. Our findings underscore the potential of combined administration of clinically available 6-MP to overcome TMZ chemoresistance and improve GBM treatment.
    DOI:  https://doi.org/10.1038/s41467-023-41663-2
  5. J Clin Invest. 2023 Sep 21. pii: e163802. [Epub ahead of print]
    A paracrine circuit of IL-1β/IL-1R1 between myeloid and tumor cells drives genotype-dependent glioblastoma progression.
    Zhihong Chen, Bruno Giotti, Milota Kaluzova, Montserrat Puigdelloses Vallcorba, Kavita Rawat, Gabrielle Price, Cameron J Herting, Gonzalo Piñero, Simona Cristea, James L Ross, James Ackley, Victor Maximov, Frank Szulzewsky, Wes Thomason, Mar Marquez-Ropero, Angelo Angione, Noah Nichols, Nadejda M Tsankova, Franziska Michor, Dmitry M Shayakhmetov, David H Gutmann, Alexander M Tsankov, Dolores Hambardzumyan.
      Monocytes and monocyte-derived macrophages (MDM) from blood circulation infiltrate glioblastoma (GBM) and promote growth. Here we show that PDGFB-driven GBM cells induce the expression of the potent pro-inflammatory cytokine IL-1β in MDM, which engages IL-1R1 in tumor cells, activates the NF-kB pathway, and subsequently leads to induction of monocyte chemoattractant proteins (MCPs). Thus, a feedforward paracrine circuit of IL-1β/IL-1R1 between tumors and MDM creates an interdependence driving PDGFB-driven GBM progression. Genetic loss or locally antagonizing IL-1β/IL-1R1 leads to reduced MDM infiltration, diminished tumor growth, reduced exhausted CD8+ T cells, and thereby extends the survival of tumor-bearing mice. In contrast to IL-1β, IL-1α exhibits anti-tumor effects. Genetic deletion of Il1a/b is associated with decreased recruitment of lymphoid cells and loss of interferon signaling in various immune populations and subsets of malignant cells and is associated with decreased survival time of PDGFB-driven tumor-bearing mice. In contrast to PDGFB-driven GBM, Nf1-silenced tumors have a constitutively-active NF-kB pathway, which drives the expression of MCPs to recruit monocytes into tumors. These results indicate local antagonism of IL-1β could be considered as an effective therapy specifically for proneural GBM.
    Keywords:  Brain cancer; Cancer immunotherapy; Immunology; Macrophages; Oncology
    DOI:  https://doi.org/10.1172/JCI163802
  6. Nat Med. 2023 Sep 21.
    A H3K27M-targeted vaccine in adults with diffuse midline glioma.
    Niklas Grassl, Isabel Poschke, Katharina Lindner, Lukas Bunse, Iris Mildenberger, Tamara Boschert, Kristine Jähne, Edward W Green, Ingrid Hülsmeyer, Simone Jünger, Tobias Kessler, Abigail K Suwala, Philipp Eisele, Michael O Breckwoldt, Peter Vajkoczy, Oliver M Grauer, Ulrich Herrlinger, Joerg-Christian Tonn, Monika Denk, Felix Sahm, Martin Bendszus, Andreas von Deimling, Frank Winkler, Wolfgang Wick, Michael Platten, Katharina Sahm.
      Substitution of lysine 27 to methionine in histone H3 (H3K27M) defines an aggressive subtype of diffuse glioma. Previous studies have shown that a H3K27M-specific long peptide vaccine (H3K27M-vac) induces mutation-specific immune responses that control H3K27M+ tumors in major histocompatibility complex-humanized mice. Here we describe a first-in-human treatment with H3K27M-vac of eight adult patients with progressive H3K27M+ diffuse midline glioma on a compassionate use basis. Five patients received H3K27M-vac combined with anti-PD-1 treatment based on physician's discretion. Repeat vaccinations with H3K27M-vac were safe and induced CD4+ T cell-dominated, mutation-specific immune responses in five of eight patients across multiple human leukocyte antigen types. Median progression-free survival after vaccination was 6.2 months and median overall survival was 12.8 months. One patient with a strong mutation-specific T cell response after H3K27M-vac showed pseudoprogression followed by sustained complete remission for >31 months. Our data demonstrate safety and immunogenicity of H3K27M-vac in patients with progressive H3K27M+ diffuse midline glioma.
    DOI:  https://doi.org/10.1038/s41591-023-02555-6
  7. Cancer Discov. 2023 Sep 21. OF1
    A Win for Targeted Therapy in Pediatric BRAF-Mutant Gliomas.
      Two reports from the phase II TADPOLE trial show the benefit of molecularly targeted therapy in pediatric brain tumors with BRAF mutations. Dabrafenib combined with trametinib was superior to chemotherapy in low-grade gliomas and yielded favorable responses in a single-arm study of high-grade ones, results that highlight the importance of biomarker testing in pediatric glioma care.
    DOI:  https://doi.org/10.1158/2159-8290.CD-NB2023-0071
  8. Clin Cancer Res. 2023 Sep 19.
    Advanced age in humans and mouse models of glioblastoma show decreased survival from extratumoral influence.
    Margaret Johnson, April Bell, Kristen L Lauing, Erik Ladomersky, Lijie Zhai, Manon Penco-Campillo, Yajas Shah, Elizabeth Mauer, Joanne Xiu, Theodore Nicolaides, Michael Drumm, Kathleen McCortney, Olivier Elemento, Miri Kim, Prashant Bommi, Justin T Low, Ruba Memon, Jennifer Wu, Junfei Zhao, Xinlei Mi, Michael J Glantz, Soma Sengupta, Brandyn Castro, Bakhtiar Yamini, Craig Horbinski, Darren J Baker, Theresa L Walunas, Gary E Schiltz, Rimas V Lukas, Derek A Wainwright.
      PURPOSE: Glioblastoma (GBM) is the most common aggressive primary malignant brain tumor in adults with a median age of onset of 68-70 years old. Although advanced age is often associated with poorer GBM patient survival, the predominant source(s) of maladaptive aging effects remains to be established. Here we studied intratumoral and extratumoral relationships between adult GBM patients and mice with brain tumors across the lifespan.EXPERIMENTAL DESIGN: Electronic health records at Northwestern Medicine and the NCI SEER databases were evaluated for GBM patient age and overall survival. The commercial Tempus and Caris databases, as well as The Cancer Genome Atlas (TCGA) were profiled for gene expression, DNA methylation, and mutational changes with varying GBM patient age. Additionally, gene expression analysis was performed on the extratumoral brain of younger and older adult mice with or without a brain tumor. The survival of young and old wild-type or transgenic (INK-ATTAC) mice with a brain tumor was evaluated after treatment with or without senolytics and/or immunotherapy.
    RESULTS: Human GBM patients ≥65 years of age had a significantly decreased survival compared to their younger counterparts. While the intra-GBM molecular profiles were similar between younger and older GBM patients, non-tumor brain tissue had a significantly different gene expression profile between young and old mice with a brain tumor and the eradication of senescent cells improved immunotherapy-dependent survival of old but not young mice.
    CONCLUSIONS: This work suggests a potential benefit for combining senolytics with immunotherapy in older patients with GBM.
    DOI:  https://doi.org/10.1158/1078-0432.CCR-23-0834
  9. Neuro Oncol. 2023 Sep 16. pii: noad172. [Epub ahead of print]
    NLGN4X TCR transgenic T cells to treat gliomas.
    C Krämer, M Kilian, Y C Chih, A Kourtesakis, D C Hoffmann, T Boschert, P Koopmann, K Sanghvi, A De Roia, S Jung, K Jähne, B Day, L D Shultz, M Ratliff, R Harbottle, E W Green, R Will, W Wick, M Platten, L Bunse.
      BACKGROUND: Neuroligin 4 X-linked (NLGN4X) harbors a human leukocyte antigen (HLA)-A2-restricted tumor-associated antigen, overexpressed in human gliomas, that was found to induce specific cytotoxic T cell responses following multi-peptide vaccination in patients with newly- diagnosed glioblastoma.METHODS: T cell receptor (TCR) discovery was performed using droplet-based single cell TCR sequencing of NLGN4X-tetramer-sorted T cells post vaccination. The identified TCR was delivered to Jurkat T cells and primary human T cells (NLGN4X-TCR-T). Functional profiling of NLGN4X-TCR-T was performed by flow cytometry and cytotoxicity assays. Therapeutic efficacy of intracerebroventricular NLGN4X-TCR-T was assessed in NOD scid gamma (NSG) major histocompatibility complex (MHC) I/II knockout (KO) (NSG MHC I/II KO) mice bearing NLGN4X-expressing experimental gliomas.
    RESULTS: An HLA-A *02-restricted vaccine-induced T cell receptor specifically binding NLGN4X131-139 was applied for therapeutic use. Reactivity, cytotoxicity, and polyfunctionality of this NLGN4X-specific TCR is demonstrated in various cellular models. Intracerebroventricular administration of NLGN4X-TCR-T prolongs survival and leads to an objective response rate (ORR) of 44.4 % in experimental gliomas-bearing NSG MHC I/II KO mice compared to 0.0 % in control groups, respectively.
    CONCLUSION: NLGN4X-TCR-T demonstrates efficacy in a preclinical glioblastoma model. On a global scale, we provide first evidence for the therapeutic retrieval of vaccine-induced human TCRs for the off-the-shelf treatment of glioblastoma patients.
    DOI:  https://doi.org/10.1093/neuonc/noad172
  10. Nat Commun. 2023 Sep 22. 14(1): 5909
    Breaking barriers for glioblastoma with a path to enhanced drug delivery.
    Imran Noorani, Jorge de la Rosa.
      
    DOI:  https://doi.org/10.1038/s41467-023-41694-9
  11. Lancet. 2023 Sep 19. pii: S0140-6736(23)01054-1. [Epub ahead of print]
    Primary brain tumours in adults.
    Martin J van den Bent, Marjolein Geurts, Pim J French, Marion Smits, David Capper, Jacoline E C Bromberg, Susan M Chang.
      The most frequent adult-type primary CNS tumours are diffuse gliomas, but a large variety of rarer CNS tumour types exists. The classification of these tumours is increasingly based on molecular diagnostics, which is reflected in the extensive molecular foundation of the recent WHO 2021 classification of CNS tumours. Resection as extensive as is safely possible is the cornerstone of treatment in most gliomas, and is now also recommended early in the treatment of patients with radiological evidence of histologically low-grade tumours. For the adult-type diffuse glioma, standard of care is a combination of radiotherapy and chemotherapy. Although treatment with curative intent is not available, combined modality treatment has resulted in long-term survival (>10-20 years) for some patients with isocitrate dehydrogenase (IDH) mutant tumours. Other rarer tumours require tailored approaches, best delivered in specialised centres. Targeted treatments based on molecular alterations still only play a minor role in the treatment landscape of adult-type diffuse glioma, and today are mainly limited to patients with tumours with BRAFV600E (ie, Val600Glu) mutations. Immunotherapy for CNS tumours is still in its infancy, and so far, trials with checkpoint inhibitors and vaccination studies have not shown improvement in patient outcomes in glioblastoma. Current research is focused on improving our understanding of the immunosuppressive tumour environment, the molecular heterogeneity of tumours, and the role of tumour microtube network connections between cells in the tumour microenvironment. These factors all appear to play a role in treatment resistance, and indicate that novel approaches are needed to further improve outcomes of patients with CNS tumours.
    DOI:  https://doi.org/10.1016/S0140-6736(23)01054-1
  12. Neuro Oncol. 2023 Sep 21. pii: noad125. [Epub ahead of print]
    Optimizing preclinical pediatric low-grade glioma models for meaningful clinical translation.
    Till Milde, Jason Fangusaro, Michael J Fisher, Cynthia Hawkins, Fausto J Rodriguez, Uri Tabori, Olaf Witt, Yuan Zhu, David H Gutmann.
      Pediatric low-grade gliomas (pLGGs) are the most common brain tumor in young children. While they are typically associated with good overall survival, children with these central nervous system tumors often experience chronic tumor- and therapy-related morbidities. Moreover, individuals with unresectable tumors frequently have multiple recurrences and persistent neurological symptoms. Deep molecular analyses of pLGGs reveal that they are caused by genetic alterations that converge on a single mitogenic pathway (MEK/ERK), but their growth is heavily influenced by nonneoplastic cells (neurons, T cells, microglia) in their local microenvironment. The interplay between neoplastic cell MEK/ERK pathway activation and stromal cell support necessitates the use of predictive preclinical models to identify the most promising drug candidates for clinical evaluation. As part of a series of white papers focused on pLGGs, we discuss the current status of preclinical pLGG modeling, with the goal of improving clinical translation for children with these common brain tumors.
    Keywords:  MAPK; genetically engineered mice; pediatric low-grade glioma; preclinical models; translation
    DOI:  https://doi.org/10.1093/neuonc/noad125
  13. J Clin Oncol. 2023 Sep 18. JCO2300493
    Inaugural Results of the Individualized Screening Trial of Innovative Glioblastoma Therapy: A Phase II Platform Trial for Newly Diagnosed Glioblastoma Using Bayesian Adaptive Randomization.
    Rifaquat Rahman, Lorenzo Trippa, Eudocia Q Lee, Isabel Arrillaga-Romany, Geoffrey Fell, Mehdi Touat, Christine McCluskey, Jennifer Wiley, Sarah Gaffey, Jan Drappatz, Mary R Welch, Evanthia Galanis, Manmeet S Ahluwalia, Howard Colman, L Burt Nabors, Jaroslaw Hepel, Heinrich Elinzano, David Schiff, Ugonma N Chukwueke, Rameen Beroukhim, Lakshmi Nayak, J Ricardo McFaline-Figueroa, Tracy T Batchelor, Mikael L Rinne, Thomas J Kaley, Christine Lu-Emerson, Ingo K Mellinghoff, Wenya Linda Bi, Omar Arnaout, Pier Paolo Peruzzi, Daphne Haas-Kogan, Shyam Tanguturi, Daniel Cagney, Ayal Aizer, Lisa Doherty, Maria Lavallee, Brittany Fisher-Longden, Shanna Dowling, Jack Geduldig, Fiona Watkinson, William Pisano, Seth Malinowski, Shakti Ramkissoon, Sandro Santagata, David M Meredith, E Antonio Chiocca, David A Reardon, Brian M Alexander, Keith L Ligon, Patrick Y Wen.
      PURPOSE: The Individualized Screening Trial of Innovative Glioblastoma Therapy (INSIGhT) is a phase II platform trial that uses response adaptive randomization and genomic profiling to efficiently identify novel therapies for phase III testing. Three initial experimental arms (abemaciclib [a cyclin-dependent kinase [CDK]4/6 inhibitor], neratinib [an epidermal growth factor receptor [EGFR]/human epidermal growth factor receptor 2 inhibitor], and CC-115 [a deoxyribonucleic acid-dependent protein kinase/mammalian target of rapamycin inhibitor]) were simultaneously evaluated against a common control arm. We report the results for each arm and examine the feasibility and conduct of the adaptive platform design.PATIENTS AND METHODS: Patients with newly diagnosed O6-methylguanine-DNA methyltransferase-unmethylated glioblastoma were eligible if they had tumor genotyping to identify prespecified biomarker subpopulations of dominant glioblastoma signaling pathways (EGFR, phosphatidylinositol 3-kinase, and CDK). Initial random assignment was 1:1:1:1 between control (radiation therapy and temozolomide) and the experimental arms. Subsequent Bayesian adaptive randomization was incorporated on the basis of biomarker-specific progression-free survival (PFS) data. The primary end point was overall survival (OS), and one-sided P values are reported. The trial is registered with ClinicalTrials.gov identifier: NCT02977780.
    RESULTS: Two hundred thirty-seven patients were treated (71 control; 73 abemaciclib; 81 neratinib; 12 CC-115) in years 2017-2021. Abemaciclib and neratinib were well tolerated, but CC-115 was associated with ≥ grade 3 treatment-related toxicity in 58% of patients. PFS was significantly longer with abemaciclib (hazard ratio [HR], 0.72; 95% CI, 0.49 to 1.06; one-sided P = .046) and neratinib (HR, 0.72; 95% CI, 0.50 to 1.02; one-sided P = .033) relative to the control arm but there was no PFS benefit with CC-115 (one-sided P = .523). None of the experimental therapies demonstrated a significant OS benefit (P > .05).
    CONCLUSION: The INSIGhT design enabled efficient simultaneous testing of three experimental agents using a shared control arm and adaptive randomization. Two investigational arms had superior PFS compared with the control arm, but none demonstrated an OS benefit. The INSIGhT design may promote improved and more efficient therapeutic discovery in glioblastoma. New arms have been added to the trial.
    DOI:  https://doi.org/10.1200/JCO.23.00493
  14. Neuro Oncol. 2023 Sep 16. pii: noad174. [Epub ahead of print]
    Indoximod-based chemo-immunotherapy for pediatric brain tumors: a first-in-children phase 1 trial.
    Theodore S Johnson, Tobey J MacDonald, Rafal Pacholczyk, Dolly Aguilera, Ahmad Al-Basheer, Manish Bajaj, Pratiti Bandopadhayay, Zuzana Berrong, Eric Bouffet, Robert C Castellino, Kathleen Dorris, Bree R Eaton, Natia Esiashvili, Jason R Fangusaro, Nicholas Foreman, Diana Fridlyand, Cole Giller, Ian M Heger, Chenbin Huang, Nadja Kadom, Eugene P Kennedy, Neevika Manoharan, William Martin, Colleen McDonough, Rebecca S Parker, Vijay Ramaswamy, Eric Ring, Amyn Rojiani, Ramses F Sadek, Sarthak Satpathy, Matthew Schniederjan, Amy Smith, Christopher Smith, Beena E Thomas, Rachel Vaizer, Kee Kiat Yeo, Manoj K Bhasin, David H Munn.
      BACKGROUND: Recurrent brain tumors are the leading cause of cancer death in children. Indoleamine 2,3-dioxygenase (IDO) is a targetable metabolic checkpoint that, in preclinical models, inhibits anti-tumor immunity following chemotherapy.METHODS: We conducted a Phase 1 trial (NCT02502708) of the oral IDO-pathway inhibitor indoximod in children with recurrent brain tumors or newly-diagnosed diffuse intrinsic pontine glioma (DIPG). Separate dose-finding arms were performed for indoximod in combination with oral temozolomide (200 mg/m2/day x5 days in 28-day cycles), or with palliative conformal radiation. Blood samples were collected at baseline and monthly for single-cell RNA-sequencing with paired single-cell T cell receptor sequencing.
    RESULTS: Eighty-one patients were treated with indoximod-based combination therapy. Median follow-up was 52 months (range 39-77 months). Maximum tolerated dose was not reached, and the pediatric dose of indoximod was determined as 19.2 mg/kg/dose, twice daily. Median overall survival was 13.3 months (n=68, range 0.2-62.7) for all patients with recurrent disease and 14.4 months (n=13, range 4.7-29.7) for DIPG. The subset of n=26 patients who showed evidence of objective response (even a partial or mixed response) had over 3-fold longer median OS (25.2 months, range 5.4-61.9, p=0.006) compared to n=37 non-responders (7.3 months, range 0.2-62.7). Four patients remain free of active disease longer than 36 months. Single-cell sequencing confirmed emergence of new circulating CD8 T cell clonotypes with late effector phenotype.
    CONCLUSIONS: Indoximod was well tolerated and could be safely combined with chemotherapy and radiation. Encouraging preliminary evidence of efficacy supports advancing to Phase 2/3 trials for pediatric brain tumors.
    Keywords:  IDO; Indoximod; brain cancer; immunotherapy; pediatric
    DOI:  https://doi.org/10.1093/neuonc/noad174
  15. N Engl J Med. 2023 Sep 21. 389(12): 1108-1120
    Dabrafenib plus Trametinib in Pediatric Glioma with BRAF V600 Mutations.
    Eric Bouffet, Jordan R Hansford, Maria Luisa Garrè, Junichi Hara, Ashley Plant-Fox, Isabelle Aerts, Franco Locatelli, Jasper van der Lugt, Ludmila Papusha, Felix Sahm, Uri Tabori, Kenneth J Cohen, Roger J Packer, Olaf Witt, Larissa Sandalic, Ana Bento Pereira da Silva, Mark Russo, Darren R Hargrave.
      BACKGROUND: Detection of the BRAF V600E mutation in pediatric low-grade glioma has been associated with a lower response to standard chemotherapy. In previous trials, dabrafenib (both as monotherapy and in combination with trametinib) has shown efficacy in recurrent pediatric low-grade glioma with BRAF V600 mutations, findings that warrant further evaluation of this combination as first-line therapy.METHODS: In this phase 2 trial, patients with pediatric low-grade glioma with BRAF V600 mutations who were scheduled to receive first-line therapy were randomly assigned in a 2:1 ratio to receive dabrafenib plus trametinib or standard chemotherapy (carboplatin plus vincristine). The primary outcome was the independently assessed overall response (complete or partial response) according to the Response Assessment in Neuro-Oncology criteria. Also assessed were the clinical benefit (complete or partial response or stable disease for ≥24 weeks) and progression-free survival.
    RESULTS: A total of 110 patients underwent randomization (73 to receive dabrafenib plus trametinib and 37 to receive standard chemotherapy). At a median follow-up of 18.9 months, an overall response occurred in 47% of the patients treated with dabrafenib plus trametinib and in 11% of those treated with chemotherapy (risk ratio, 4.31; 95% confidence interval [CI], 1.7 to 11.2; P<0.001). Clinical benefit was observed in 86% of the patients receiving dabrafenib plus trametinib and in 46% receiving chemotherapy (risk ratio, 1.88; 95% CI, 1.3 to 2.7). The median progression-free survival was significantly longer with dabrafenib plus trametinib than with chemotherapy (20.1 months vs. 7.4 months; hazard ratio, 0.31; 95% CI, 0.17 to 0.55; P<0.001). Grade 3 or higher adverse events occurred in 47% of the patients receiving dabrafenib plus trametinib and in 94% of those receiving chemotherapy.
    CONCLUSIONS: Among pediatric patients with low-grade glioma with BRAF V600 mutations, dabrafenib plus trametinib resulted in significantly more responses, longer progression-free survival, and a better safety profile than standard chemotherapy as first-line therapy. (Funded by Novartis; ClinicalTrials.gov number, NCT02684058.).
    DOI:  https://doi.org/10.1056/NEJMoa2303815
This page is being maintained by Thomas Krichel. It was last updated on 2023‒09‒24 at 0:30.