- EANO webinar Tumorboard 3, April 28, 202116:00-17:30 (CET) (content educational)
- EANO webinar on Recurrent Glioblastoma, May 26, 2021 16:00-17:30 (CEST) (content educational)
⇒Click here to book you place!
Further eEANO webinars to come last Wednesday each month!
In Sweden, approximately 63 000 people are diagnosed with a cancer disease and around 1 400 new primary brain tumours are seen every year. The cancer care is integrated in general hospitals, without any specific cancer hospitals and the Swedish government have established six regional cancer centres. All centres have to coordinate well aligned patient focused specific care processes in all cancer diseases and together develop national guidelines. The survival of cancer patients is high in an international comparison for most cancer diseases; however, we do also have specific challenges within Neuro-Oncology. We still need to improve long waiting times and reduce the regional variability in waiting times, and we have a relative lack of neuropathologists and neuroradiologists. Better co-ordination of research activities is desirable, and there is an important need to get a better patient focus with increased participation in their own care.
The Swedish Brain Tumour Group (SBTG)
SBTG was founded 1993 with two initial main goals, i.e. to create a public awareness of a neglected patient group in the society and to improve health care standards for patients suffering from brain tumours. SBTG is supported by the national Cancer foundation and by the clinics responsible for the caring of brain tumour patients. The involved clinics are mainly located at university hospitals, but some patients are also given non- surgical treatment at clinics outside the universities. SBTG has a more strategic-political role, including responsibility for clinical studies. SBTG has two subgroups, one group is dealing with National Guidelines for all primary brain tumours. The other subgroup, The National Quality Registry (NQR), has a responsibility for the national registration of clinical data, including online registration of data of value in the direct management of the patients.
The National Quality Registry (NQR)
Sweden has several national clinical databases related to cancer, including the compulsory National Cancer Registry to which all patients diagnosed with cancer are reported since 1958. NQR for primary brain tumours was started 1999 and extended to follow up registration 2006. This registry has recently undergone an extensive makeover and will include all types of primary brain tumours. NQR is tightly coupled to the national guidelines, and will soon be directly connected to patients’ records. The NQR cover aspects not included in the compulsory National Cancer Registry, such as specific symptoms, details of treatments, time for management, complications and molecular data.
An important activity has been to promote neurooncological research. SBTG has initiated and finalised several important national/international clinical and epidemiological studies. Members of the group have important roles in various experimental studies of brain tumours. Especially valuable is that NQR can be synchronized with other registries in the society, such as information about socio-economy, and that NQR can be used together with molecular data from biobanks. SBTG have a close collaboration with other professional societies and is also a part of the Scandinavian Neuro-oncology Group (SNOG) in the framework of collaboration between the Nordic countries. Several scientific publications have come out from all these collaborations.
Patients and related parties
Members of the national group have supported the foundation of a specific Patient Advocacy Group for brain tumour patients and patients are now members of SBTG and the subgroups. Since 2006, an annual common national meeting has been arranged for patients, public and care givers.
Important to consider who we reach with our efforts, and when?
Equal cancer care and diversity among leading positions
The challenges with an unequal care are also of high priority for groups like SBTG. Most importantly, the work by NQR and the national guidelines must emphasize how to achieve an equal cancer care around the country to all patients regardless of position in the society or residence. To create an equal care, it is of utmost importance that these efforts also are mirrored in the management teams and in the research. In this context, it is gratifying to see that aspects around equal cancer care and diversity among leading positions, discussed during EANO 2018 in Stockholm, now seems to be increasingly adopted and integrated by EANO.
SBTG will continue its work with a patient perspective for an equal and fair cancer care for all patients. There is much more to do for all of us. Therefore, it is of importance to further improve our cooperation with other national and international organisations, as well as support interdisciplinary collaboration.
Roger Henriksson, Senior Professor - Chief Physician, Oncology & Radiotherapy, Chairman of SBTG, firstname.lastname@example.org
Asgeir Jakola, Associate professor, Consultant in Neurosurgery, Member of EANO Executive Board, email@example.com
The Portuguese Neuro-Oncology Association (Associação Portuguesa de Neuro-Oncologia – APNO) annually gathers health care professionals and researchers from different institutions across the country, to discuss the latest topics and discoveries in the field of Neuro-Oncology.
It is usually a one-and-a-half-day meeting where we privilege the interaction between the participants, the multidisciplinary discussion of difficult clinical cases and the oral or poster presentation of selected abstracts.
The APNO is committed to foster the networking between clinicians devoted to the treatment of patients with tumors of the Central Nervous System and researchers in the field. We believe this joint effort will contribute to a better understanding of the mechanisms underlying the development and progression of brain tumors, and will accelerate the discovery of novel therapies. To this end, efforts have been made to develop a national study on the clinical and molecular features of long-term survivors of glioblastoma.
We are also interested in promoting training and education in Neuro-Oncology. A session was devoted to this topic in the last meeting and an inspiring lecture was given by Dr. José Bravo Marques, renowned Neuro-Oncologist and the founder of APNO. The APNO annual meeting is a great opportunity for medical residents, PhD students and Master students to present their work. The best oral communications and poster presentations are awarded.
Due to the Covid-19 pandemic, the annual meeting in 2020 was postponed but we will resume our activities in 2021.
We recognize that a closer proximity of our national society to the European Association of Neuro-Oncology (EANO) and its members will enrich our community, promote the establishment of collaborations and benefit our patients.
Claudia Faria MD, PhD, President of APNO
The book on complications of cancer therapy has been edited by 4 experienced editors; Cavaletti G, Grisold W, Oberndorfer St and Soffietti R and contains 35 chapters written by international experts in the field.
According to the WHO, cancer is the second leading cause of death globally. Despite the improvement of cancer treatment and concepts, neurological side effects of anticancer therapy remain frequent and are often associated with serious complications. Neurologists need to be aware of upcoming new oncologic treatment concepts and corresponding possible toxic side effects on the nervous system.
In addition, the classic combination of surgery, radiotherapy, chemotherapy and hormonal therapy, receives new approaches as targeted therapies, immune check point inhibitors and Car T cell therapies among others. In several cancer types, new treatment approaches prolong survival and may even cure patients. Thus a new category of cancer patients, long term survivors appear which may have transient or permanent damage of the nervous systems.
The volume 1 book focuses on the basic concepts of cancer, and also epidemiology in regard to neurological involvement. Measuring side effects by scales and scores is important, as well as the quantification of toxic effects.
The book contains several chapters on patient issues, as the involvement in study design, care for patients and families, patient groups, palliative care and also an analysis of the cancer situation on low and middle income countries.
The volume 2 book focuses of side effects of cancer therapies as surgery, chemotherapy, radiotherapy, targeted therapies, immune check point inhibitors and the armamentarium of emerging new cancer therapies.
The peripheral nervous system is discussed in detail in regard to cranial nerves, nerve roots, plexus and poly- and mononeuropathies, as well as the neuromuscular junction and muscle. The frequent and important topic of sarcopenia and cachexia closes this volume.
The book will facilitate and help to be able to find the accurate diagnosis in cancer patients, where neoplastic, hormonal and infection and rarely paraneoplastic causes are often difficult to discriminate from treatment side effects, but require an entirely different therapeutic approach.
The intention of this book is not only to point out and describe the numerous effects of cancer therapy, but also to update the present knowledge on neurotoxic side effects, and include general and in particular patient related issues.
Editors; W Grisold , Vienna; G Cavaletti , Monza; St Oberndorfer, St Pölten; R Soffietti , Turin.
Publisher: Cambridge Scholars, 2021
Volume 1: 434 pages, November 2020, ISBN: 1-5275-5888-6, ISBN-13: 978-1-5275-5888-5, 74,99 Euro, https://www.cambridgescholars.com/product/978-1-5275-5888-5
Volume 2: 406 pages, Februar 2021, ISBN: 1-5275-6087-2, ISBN-13: 978-1-5275-6087-1, 64,99 Euro, https://www.cambridgescholars.com/product/978-1-5275-6087-1
EANO wishes to strengthen the role and functioning of nurses and health allied personal dedicated to brain tumor patients. We have therefore decided to establish a nurse/allied health professional (AHP) Committee, to improve education, science and communication for this important topic and this important group of professionals.
The first nurse/allied health professional Committee will be chaired by Karin Piil and will concentrate its activities on developing a clinical and scientific network within EANO to embrace nurses/AHP in an enhanced manner. The Committee advocacy better recognition of the various neuro-oncological disciplines across Europe to ensure that an evidence-based care and treatment are provided to our patients and their families by highly educated, empowered and competent nurses and AHPs. We encourage more nurses/AHP to be dedicated to neuro-oncology clinical practice, scientific positions and as leaders within multi-professional teams
Applicants must be members of EANO (i.e. paid-up members) with residency in a European country.
Applications for the Executive Board at the same time are not possible; applications for another EANO Committee is possible by indicating primary and secondary choices, also former Executive Board members are very welcome to apply!
click here for application details
The EANO Executive Board as well as the Chairs of the Committee Karin Piil are looking forward to receive your application!
Application deadline May 31, 2021!
We are pleased to announce our call for the next EANO President-Elect. We invite current and former members of the Executive and General Board so send applications to firstname.lastname@example.org including a motivation letter and short CV. Application deadline May 31, 2021. The person so elected shall be member of the Executive Board as the “president elect”, for one year until taking over the position of EANO President 2023/24. The president will be confirmed by the General Assembly and serve for two years and may not be re-elected. After his/her term of office, s/he will automatically become the past president, with a two-year term of office, to support the incoming president and as such will be part of the Executive Board.
Abstract submission for EANO 2021 is now open! The Scientific Committee looks forward to receiving your abstracts to one of the various topics. The application deadline is Monday, April 19, 2021. For details on how to submit an abstract, guidelines, submission topics, etc. visit the EANO Meetings website.
We (the members of the RANO-PRO working group) invite all healthcare professionals involved in the care of brain tumor patients to participate in a survey initiated by the Response Assessment in Neuro-Oncology – Patient Reported Outcome (RANO-PRO) working group. This working group aims to provide guidance on the use of patient-reported outcome (PRO) measures in clinical trials and practice for adult patients with brain tumors. With this international survey we aim to identify which aspects of functioning are important for brain tumor patients. The questionnaire is based on aspects specified in the WHO International Classification of Functioning Disability and Health (WHO ICF) framework.
The results of this survey will be used to determine the content validity of PRO measures that are currently used in brain tumor research.
Completion of the questionnaire will take approximately 10-20 minutes, and can be accessed using the following link: https://www.surveymonkey.com/r/TKSDY9H
We are grateful if you take the time to complete this survey.
On behalf of all members of the RANO-PRO working group
The ANOCEF (Association des Neuro-Oncologues d’Expression Française) was created in 1993. Its missions originally consisted in the formation of a multidisciplinary learned society but as time went by, it gradually started supporting research on neuro-oncology. The ANOCEF recently set up a research group named IGCNO dedicated to the promotion of clinical research projects and sponsor clinical trials, whose work has been endorsed by the French National Cancer Institute (INCa).
Organization: The ANOCEF directly answers to a Board (which consists of 30 members from several countries including representatives from Switzerland, Belgium and Canada), which is subjected to re-election every 3 years. Its body comprises about 300 active members including physicians from different disciplines, researchers and health professionals. It also has at its disposal a network of 35 centers across the country which provides neurooncology multidisciplinary consultation meetings and takes active part in clinical trials. The INCa is the main agency providing the ANOCEF with funding through structuring public calls, patient’s association subventions (ARTC), industrial partnerships, and individual membership fees.
Education: The ANOCEF organizes an annual scientific congress during the spring as well as two educational meetings. In 2004, the ANOCEF also created a postgraduate curriculum delivering a national degree of neuro-oncology of which 13 universities have been a part. In 2020, 85 participants enrolled to the programme. Furthermore, six years ago, a curriculum dedicated to nurses was also created. The ANOCEF has carried out multiple national guidelines in order to improve and standardize the management of brain tumors throughout the country.
Research: Theme working groups have been set up within the ANOCEF, covering the different fields of neuro-oncology and their primary tasks consist in developing clinical and translational research studies. The ANOCEF also disposes of an executive committee aiming at evaluating and coordinating the projects, but also at applying for calls. For instance, 9 ongoing clinical trials (phase I, II, III) have succeeded in obtaining public funding such as for phase III, the POLCA and POLO trials– evaluating the role of deferred radiotherapy in 1p/19q codeleted anaplastic and in codeleted low grade gliomas respectively, and the BLOCAGE trial evaluating the role of maintenance chemotherapy in the elderly suffering from primary CNS lymphoma. The centers belonging to the ANOCEF’s network also take active part in international trials, especially those conducted by the EORTC brain tumor group.
Health care networks: ANOCEF aims to structure the clinical research on neuro-oncology but also to improve the management of rare cancers through dedicated networks. At the moment, ANOCEF has set up nine several national network devoted to specific tumor types or clinical entities (anaplastic gliomas, brainstem tumors, diffuse low grade gliomas, glioneuronal tumors, meningiomas, spinal cord tumors, primary CNS lymphomas, tumors of adolescent and young adults, treatment related neurotoxicities) and provides dedicated expert web conferences organized on regular fixed dates and with a designated coordinator. Thus, when confronted to particularly complex cases, a colleague anywhere in the country can now ask for a histological central review by an expert neuropathologist belonging to the RENOCLIP group and/or solicit a national multidisciplinary expert meeting for practical recommendations and second opinions. All the networks have a specific updated data base to register and follow the patients.
International relationships : The ANOCEF is the national contact with the European Association of Neurooncology (EANO) and the World Federation of Neurooncology (WFNO). ANOCEF also formed a partnership with AROME (Association of Radiotherapy and Oncology of the Mediterranean area) and an annual joint education meeting of neuro-oncology in the Maghreb (Tunisia, Marocco, Algeria alternatively). Educational and training projects with sub-Saharan African countries have also been planned as part of a broader project by the French Society of Neurology.
Khê Hoang-Xuan, MD, PhD
Department of Neurology- Division Mazarin
Groupe Hospitalier Pitié-Salpêtrière
47, Boulevard de l’Hôpital
Paris 75013, FRANCE
Czech Society for Neuro-Oncology (CSNO) has been established in 2011 as a member of the Czech Oncological Society. The main aim of the Society is to contribute to the development and dissemination of knowledge in clinical and biomedical sciences focused on neuro-oncology, to enable the translation of this knowledge into the clinical practice and current standards of care for patients with CNS tumors, and to participate on the education of all the health care professionals and scientists of the neuro-oncology community.
Specific objectives include:
- Preparation and implementation of national standards for the treatment of patients with CNS tumors,
- Establishment of the network of CSNO centers following CSNO guidelines in their clinical routine and research activities (biobanking, collection of clinical data) in neuro-oncology,
- Facilitation of interactions of health care professionals and scientists with an interest in neuro-oncology,
- Support of a multidisciplinary cooperation of clinical and scientific teams involved in high-quality neuro-oncological research,
- Management and coordination of clinical and translation multicenter studies in neuro-oncology within the CSNO network in the Czech Republic and abroad.
CSNO joins professionals involved in all relevant modalities of treatment as well as researchers participating on the basic, applied and translational research in the field, to improve the diagnostics and treatment of patients and to create a nationwide platform with the potential to participate in European research networks.
The section postulated, published and now guarantees Czech clinical neuro-oncology guidelines. Every year, the section organizes its own symposia in ESMO labelled meetings Prague Oncology Colloquium and Brno Oncology Days. The Section is also an important partner of the local representation of EANS.
Currently, the CSNO network is composed of 8 centers (Prague – Na Homolce Hospital, Prague - The Military University Hospital, Brno – Masaryk Memorial Cancer Institute, Hradec Kralove – University Hospital, Olomouc – University Hospital, Ostrava – University Hospital, Plzen – University Hospital, Usti nad Labem – Masaryk Hospital) and 1 associated center (Ceske Budejovice – Hospital Ceske Budejovice). The staff of each center involves experts in radiodiagnostics, neurosurgery, neuropathology, oncology, radiotherapy and biomedical research. The society has about 70 members and within its network, approximately 600 patients per year are surgically treated for glioma.
President of the Board Scientific Secretary
Prof. Aleksi Sedo, MD, PhD. Tomas Kazda, MD, PhD.
1st Faculty of Medicine, Charles University, Prague Masaryk Memorial Cancer Institute, Brno
EANO announces the publication of new guidelines for the diagnosis and treatment of gliomas in adulthood. An update of these guidelines became necessary because of major advances in the molecular classification and understanding of these tumors.
Furthermore, the impact of recent, in part practice-changing clinical trials for neuro-oncology practice across Europe had to be evaluated and placed in perspective for our community.
We are very grateful to the reviewers and the editorial team at Nature Reviews in Clinical Oncology for giving us the opportunity of publishing our new guideline in such a prestigious journal.
Weller, M., van den Bent, M., Preusser, M. et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol (2020). https://doi.org/10.1038/s41571-020-00447-z
Find out more about what has happened within EANO in 2020 by reading our annual report! It contains more information on the topic of the upcoming EANO Meeting and eEANO Webinars, the very active Disparity, Educational, Guideline, Scientific, Publication Activity and Youngsters Committee.
Click here to read the full Annual Report
Neurological and vascular complications of primary and secondary brain tumours
Patients with brain tumors are at an increased risk of developing neurological or vascular complications, which may severely impair the patients' quality of life. A group of experts from different disciplines developed a joint guideline on behalf of EANO and ESMO, which provides recommendations on the management of such complications. The guideline covers several clinically relevant topics such as brain edema, seizures, neurocognitive impairment, venous thromboembolism, stroke, intracranial hemorrhage, metastatic spinal cord compression (MSCC) and supportive and end-of-life care. The guideline provides recommendations for the diagnosis and treatment as well as levels of evidence and grades of recommendation where applicable.
Roth P, Pace A, Le Rhun E, Weller M, Ay C, Cohen-Jonathan Moyal E,Coomans M, Giusti R, Jordan K, Nishikawa R, Winkler F, Hong JT, Ruda R, Villà S, Taphoorn MJB,Wick W, Preusser M, on behalf of the EANO Executive Board, on behalf of the ESMO GuidelinesCommittee, Neurological and vascular complications of primary and secondary brain tumours: EANO-ESMO Clinical Practice Guidelines for prophylaxis, diagnosis, treatment and follow-up†, Annals ofOncology (2020), doi: doi.org/10.1016/j.annonc.2020.11.003.
Oligodendrogliomas are primary brain tumours characterised by co-deletion of chromosome regions 1p and 19q and, almost always, mutations in isocitrate dehydrogenase genes (IDH-1 or IDH-2). These genetic features are generally associated with a good prognosis and oligodendrogliomas are commonly described as being highly responsive to alkylating chemotherapy agents such as temozolomide (TMZ). This chemosensitivity led researchers to question whether it might be possible to omit or delay the use of radiotherapy (RT) in this group of patients. To ask this important question, an international team of researchers from multiple centres across Europe and North America overcame multiple challenges to set up the CODEL trial. Patients with newly diagnosed 1p/19q codeleted WHO grade III anaplastic oligodendroglioma were randomised to receive either radiotherapy alone (Arm A, 59.4 Gray in 33 fractions), radiotherapy with concomitant and adjuvant TMZ (Arm B) or TMZ alone (Arm C).
The results from the first 36 patients were published in Neuro-Oncology in July (Jaeckle KA et al, DOI: 10.1093/neuonc/noaa168) and made striking reading despite the very small number of patients. Median progression-free survival (PFS) was significantly shorter in patients receiving TMZ only (2.9 years) than in patients receiving radiotherapy either with or without TMZ (Arms A and B were pooled for this analysis; median PFS not reached after 6.6 years of follow up – see Figures full article for details). The hazard ratio (HR) was 3.12 (p=0.009). Despite the fact that all Arm C patients who progressed on TMZ went on to receive RT (either alone or with TMZ), there was also a trend towards reduced overall survival in this group (HR = 2.14, p=0.27).
Although the numbers are small, this important study provides a powerful illustration of the effectiveness of radiotherapy in anaplastic oligodendroglioma, a phenomenon that had previously been somewhat overshadowed by the focus on chemosensitivity. Partly in response to these data, the CODEL trial has been redesigned so that all patients will receive radiotherapy, either with concomitant and adjuvant TMZ or with adjuvant PCV chemotherapy.
One of the original motivations for the CODEL trial was to ask whether omitting or delaying RT might improve neurocognitive outcomes. Within the limitations of this small study, in which 81% of patients completed the full battery of cognitive tests at baseline and the 3-month timepoint, no differences were observed between patients receiving RT (Arms A and B combined) or TMZ only (Arm C). While these preliminary findings are reassuring, the important question is whether irradiated patients will suffer delayed neurotoxicity in the years and decades after treatment. In the meantime, RT has been firmly established as the cornerstone of treatment for anaplastic oligodendroglioma and the exciting opportunities to combine it with new, molecularly targeted drugs will be discussed in a future edition of the EANO newsletter.
Kurt A Jaeckle, Karla V Ballman, Martin van den Bent, Caterina Giannini, Evanthia Galanis, Paul D Brown, Robert B Jenkins, J Gregory Cairncross, Wolfgang Wick, Michael Weller, Kenneth D Aldape, Jesse G Dixon, S Keith Anderson, Jane H Cerhan, Jeffrey S Wefel, Martin Klein, Stuart A Grossman, David Schiff, Jeffrey J Raizer, Frederick Dhermain, Donald G Nordstrom, Patrick J Flynn, Michael A Vogelbaum, CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design, Neuro-Oncology, , noaa168, https://doi.org/10.1093/neuonc/noaa168
The EANO Youngsters initiative connects young Neuro-Oncology scientists within the EANO and provides a platform for interaction. This year, the COVID-19 pandemic has postponed the annual Networking Event and Winter School. Now we need your help to reach out to young PhD candidates, residents and other professionals in the field of Neuro-Oncology. Please forward the contact details to your junior colleagues.
The EANO Youngsters committee
The Gold standard treatment for brain tumors benign and malignant is the operation. Most of the tumors are inoperable due to their anatomical location. In some cases a subtotal resection is occurred. The radiation treatment has a significant role for the further management for the treatment for brain tumors. Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) are specific techniques to deliver precisely directed high-dose irradiation to the target in the brain and at the same time, it has minimal dose for the normal tissue. The biologic effective dose (BED) is very high due to the high dose irradiation with the result of high local tumor control. The radiosurgery occurs in one fraction with high dose and the stereotactic fractionated radiotherapy is the treatment with high dose in more than one fraction. The conventional radiation techniques have a standard 1-2 cm safe margin round the target. The stereotactic techniques radiate exact without safe margin or with 1-2mm due to the high dose that they deliver so the head has to be fixated with a special stereotactic thermoplastic mask. For the clinical target definition the fusion of MRI and CT scan and in some cases FET-PET scan is necessary. The toleration of stereotactic techniques is very good without significant side effects compared the conventional radiation techniques due to the fact the normal tissue receives minimal dose. The indication for radiosurgery or stereotactic radiation has a wide spectrum in the brain for brain metastasis, acustic neurinomas,craniopharyngiomas, meningiomas, arteriovenusmalformation (AVM), pituitary gland adenomas, glomus tumor with about 90 % local tumor control according to the national publications. Glioma recurrence can also be radiated with stereotactic technique in case that the recurrence is inoperable. Single brain metastasis that is not operable can be treated with radiosurgery with 90% local control according to the national publications. In case the single brain metastasis are operated even though with total resection a stereotactic radiation to the operation cavity is indicated.
A precise diagnosis and monitoring of brain tumors are essential for a differentiation of tumor types with different prognosis, evaluation of disease trajectory, and choice of optimal therapeutic approaches.
During the course of the disease, longitudinal biopsies may be required to complement the imaging techniques to help differentiate disease progression from a pseudo-progression induced by treatments. Moreover, tumors commonly undergo molecular evolution and the genomic landscape at relapse may have different characteristics as compared to the original diagnosis.
Liquid biopsies have been shown to provide information about the patient’s tumour molecular profile and the evolution of cancer in a minimally invasive way. A liquid biopsy consists of analysing biomarkers, including cell-free circulating tumour DNA (ctDNA), circulating tumour cells (CTCs) or exosomes that are present in body fluids. Plasma has been initially disappointing as a source of ctDNA for patients with CNS disease, but in the last years there has been an improvement of techniques. Conversely CSF has been reported to be able to yield a major amount of genetic material from the tumor.
WHO 2016 has updated the classification of gliomas by incorporating molecular characteristics. In this regard, the analysis of the mutational status of IDH1, IDH2, ATRX, TP53, TERT, H3F3A and HIST1H3B in the CSF ctDNA now allows a molecular diagnosis of diffuse gliomas and provides information about the prognosis (Martinez-Ricarte F et al, 2018). For patients with diffuse midline gliomas, there is a high risk of morbidity associated with tumour biopsy due to the anatomical location: in such instance, diagnosis could be obtained by the analysis of H3F3A and HIST1H3B mutations in the CSF ctDNA (Azad TD et al, 2020). Moreover, in a pilot study, the detection of TERT promoter mutations in the CSF ctDNA of patients with GBM was associated with outcome: patients with increased VAF showed shorter overall survival (Juratli TA et al, 2018).
There are limited therapy-related biomarkers for patients with gliomas: MGMT promoter methylation status is the most relevant biomarker and has been detected with higher sensitivity in the CSF than serum (Wang Z et al, 2015). In addition, the analysis of EGFR amplification and EGFRvIII mutation in the CSF has a therapeutic impact for patients with glioblastoma, treated with EGFR-targeted therapies (Figueroa JM et al, 2017)
Mutational changes have been detected in glioma patients during longitudinal analysis of CSF ctDNA, paralleling the evolution of the glioma genome (Miller AM et al, 2019).
Overall, CSF ctDNA from patients with diffuse gliomas contains the full spectrum of genetic alterations found in tumor tissue, including missense mutations, copy number alterations and structural changes. The ability to detect these molecular alterations appears to be greatest using PCR-based single gene assays.
For the future we expect an increase use of serial liquid biopsies to tack molecular evolution of tumors in clinical trials when using targeted agents.
When diffuse midline glioma, H3 K27 mutant (DMG) was introduced into the WHO classification of brain tumors 2016, it seemed to be a highly distinct and biologically rather homogeneous group. Their defining histone mutation along with a sharp demarcation of epigenetic features, and often younger patient age compared to other high-grade gliomas rendered a very distinct tumor type.
However, recent studies suggest that DMG is not that homogeneous. A novel study from UCSF reports on a subset of pediatric bi-thalamic glioma that harbor H3 mutations to much lower extent, but instead activating mutations or amplifications of EGFR (PMID 32303840). So far, EGFR activation was thought to be largely confined to adult glioblastoma IDH wildtype. He mutations were rare and also co-occurred with EGFR alterations. These cases did not align with other DMG in epigenetic analysis but formed a separate group. In combination with an earlier report on EZHIP overexpression as a mechanism alternative to H3 mutation in inhibition of PRC2 (PMID 32193787), these findings warrant to consider the definition of “diffuse midline glioma” and further investigation on the clinical and therapeutical implications of these subtypes.
Mondal, G., Lee, J.C., Ravindranathan, A. et al. Pediatric bithalamic gliomas have a distinct epigenetic signature and frequent EGFR exon 20 insertions resulting in potential sensitivity to targeted kinase inhibition. Acta Neuropathol 139, 1071–1088 (2020). DOI: https://doi.org/10.1007/s00401-020-02155-5
Internationally, we have dedicated neuroscience nurses, neuropsychologists, and AHPs who coordinate and lead research and clinical practice to continually improve the quality of life of the patients with a brain tumor and the neuro-oncology caregiver. Still, we need to strengthen our delivery of supportive-care strategies to ensure that they are based on an evidence-based systematic approach that spans the disease trajectory from diagnosis until end-of-life as well as ensure proper support for the bereaved.
Join the eEANO webinar on the 23rd September to learn about the psychological adjustment and supportive care needs of patients with a brain tumor and their caregivers and how to address these. Participating in this webinar will inspire attendees to establish supportive care interventions to optimize the quality of life for our patients and their relatives.
Ownsworth, T, Chambers, S. Damborg, E, Casey, L. Walker, D., Shum, D. Evaluation of the making sense of brain tumor program: a randomized controlled trial of a home-based psychosocial intervention. Psycho-Oncology 24: 2015.
Page, M. The UCSF Neuro-Oncology Gordon Murray Caregiver Program, an example of successful integration of caregiver support into the neuro-oncology clinic. (2019)
Boele, F. W., Klein, M., Verdonck-de Leeuw, I. M., Cuijpers, P., Heimans, J. J., Snijders, T. J., Vos, M., Bosma, I., Tijssen, C., & Reijneveld, J. C. (2018). Internet-based guided self-help for glioma patients with depressive symptoms: a randomized controlled trial. Journal of neuro-oncology, 137(1)
Piil K, Jakobsen J, Christensen KB, et al. Needs and preferences among patients with high-grade glioma and their caregivers – A longitudinal mixed-methods study. Eur J Cancer Care. 2018
The emergence of immune checkpoint inhibitors has led to a revolution in the therapeutic management of various types of cancer. Therefore, there was great hope that these drugs would also be active against primary brain tumors such as glioblastoma. The CheckMate 143 trial is the first completed randomized study to evaluate an immune checkpoint inhibitor in patients with recurrent glioblastoma. The main results of the trial, that is, the lack of a survival benefit of the PD-1 inhibitor nivolumab compared to bevacizumab, had been known for some time. Now, the full report on this trial is available (see publication link below). The overall disappointing results suggest that "all-comers strategies" are most likely not the right approach to implement immunotherapy as a successful treatment strategy against glioblastoma. A subgroup analysis suggests that patients with MGMT promoter-methylated tumors who had not received steroid therapy at the time of enrolment, may have benefited more from nivolumab than from bevacizumab. In view of the small number of patients in these analyzes, these data must be interpreted with caution. Overall, a comprehensive and careful analysis of the dataset of this and similar studies is mandatory to improve the design of future clinical trials assessing immune checkpoint inhibitors or other immunotherapeutic approaches in glioblastoma patients.
Reference: Reardon DA, Brandes AA, Omuro A, et al. Effect of Nivolumab vs Bevacizumab in Patients With Recurrent Glioblastoma: The CheckMate 143 Phase 3 Randomized Clinical Trial. JAMA Oncol. 2020;6(7):1003–1010. doi:10.1001/jamaoncol.2020.1024
Prescription preferences of antiepileptic drugs (AEDs) in brain tumor patients: an international survey
Antiepileptic drugs (AEDs) are the cornerstone of therapy in patients with brain tumor related epilepsy. The number of different AEDs has significantly increased over the past 30 years. To get more insight into the current prescription preferences among the neuro-oncological community, Dr. Johan Koekkoek and Dr. Roberta Rudà have composed a short survey on AED use in brain tumor patients.
We would very much appreciate if you take the time to fill in the questionnaire, it only takes 5-10 minutes.
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Neurosurgical management of patients with brain tumors consist of some long-standanding controversies. One such controversy is whether performing a so-called supramarginal resection in patients with glioblastoma offers a significant survival benefit. A supramarginal resection can pragmatically be defined as anything beyond the contrast enhancing tumor, making the resection cavity larger than the contrast enhancing tumor was in the first place. Current evidence consist of retrospective case-series and the most recent systematic review on the topic was recently published in Journal of Neuro-oncology by Jackson et al. from Johns Hopkins (doi.org/10.1007/s11060-020-03556-y), and they reached a similar conclusion to previous reviews that supramarginal resections seems associated with prolonged survival. In this review, they emphasize that a more anatomical resection (e.g. anterior temporal lobotomy) may be more beneficial than just extending margins.
Interestingly, to better answer the controversy a European randomized study on the topic of supramarginal resection has just opened (www.supramarginaltrial.com) and is recruiting.
Neurosurgical oncology is not only about prolonging life. Another crucial aspect of is to preserve function and recently an excellent paper of the so called “triple motor mapping” was published by Gogos and co-workers from UCSF in Journal of Neurosurgery (doi.org/10.3171/2020.3.JNS193434). In experienced hands this technique allows for safe resection of tumors near the motor cortex and corticospinal tract with surgery under general anesthesia. The publication has nice illustrations for demonstration of this highly useful technique.
Orthotopic patient-derived brain tumour models available on PDXFinder supporting the worldwide use of these key tools for translational brain tumour research.
In order to study tumor evolution and drug response, and thereby develop novel therapeutic options, experimental models that accurately represent a patient’s tumour are of utmost importance in the preclinical setting. A comprehensive cohort of over 40 Patient-Derived Orthotopic Xenografts (PDOXs) of malignant gliomas has now been made publicly available on PDXfinder, an open global PDX model catalogue co-developed by the European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL - EBI) and the Jackson Laboratory and supported by the EuroPDX consortium.
These glioma PDOXs consist of human tumour organoids – three-dimensional tissue cultures derived from viable cells from patient tumours – which are subsequently implanted in immunodeficient mice. These models act as clinically relevant patient “avatars”, faithfully reflecting the main biological, histological and genomic features of the original patient tumor. The currently available data includes patient information, such as gender, age, diagnosis, type (primary/recurrent), site and grade. The remaining information, such as the genetic and molecular characteristics, methods of implantation, tumor histology, drug response and quality assurance methods, will be available soon.
The glioma PDOX cohort includes primary and recurrent gliomas, at different stages, from different subtypes and carrying different mutations. It also includes longitudinal PDOXs derived from tumour samples of the same patient prior to and after treatment, which constitutes an invaluable research tool to study glioma progression and treatment response. The cohort has been contributed by the NORLUX Neuro-Oncology Laboratory from the Luxembourg Institute of Health.
The International Brain Tumour Alliance (IBTA) has released the 'Brain Tumour Patients' Charter of Rights', to achieve the best possible health and quality of life outcomes for adults and children living with a brain tumour. A document supported by EANO and over 70 international organisations, to represent an aspirational ideal against which quality standards, policies and practices are developed, monitored and delivered. Goals aiming to reduce inequalities from country to country and support better outcomes.
In the past decade, prognosis of patients with brain metastases has improved, both by improved local treatments but in particular by more effective systemic treatments. Moreover, because of this improving survival, more patients are at risk to develop brain metastases. And, as another consequence, the role of local treatments is increasing significantly. This makes the approach to patients with brain metastases much more complex and challenging, and raises questions about how to best combine stereotactic radiotherapy with systemic treatments.
In an excellent overview by Page et al results from studies on systemic treatment alone and in combination with local radiotherapy of patients with brain metastasis from non-small cell lung cancer are reviewed. The authors present a state of the art overview of the efficacy of novel targeted and immunological treatments for NCSLC patients with brain metastases, alone and in combination with local radiotherapy and provide recommendations for future trials as more evidence is clearly needed. And approaches may actually differ for the various mutational NSCLC subtypes. Retrospective data suggest that especially in EGFR mutant tumors there may be benefit if tyrosine kinase inhibitors are combined early with local radiotherapy. Similar question now rise in NSCLC patients with brain metastases treated with immunotherapy. This review nicely captures the many sides of this problem, which urgently requires answers.
Reference: Page, S., Milner-Watts, C., Perna, M. et al. (2020). 'Systemic Treatment of Brain Metastases in Non-Small Cell Lung Cancer', European Journal of Cancer, 132 (June), pp. 187-198 PMID: 32380429 DOI: 10.1016/j.ejca.2020.03.006
The EANO Youngsters have performed an international survey on perioperative imaging routines in brain metastasis patients. A standardized questionnaire was distributed in the EANO network and was completed by 120 physicians. The results show high variability in imaging procedures in the perioperative management of brain metastasis patients with regard to imaging modalities and time-points. The results from this study highlight the need for standardisation of clinical routines in patients with brain metastases.
Reference: Kiesel, B., Thomé, C.M., Weiss, T. et al. Perioperative imaging in patients treated with resection of brain metastases: a survey by the European Association of Neuro-Oncology (EANO) Youngsters committee. BMC Cancer 20, 410 (2020). doi: 10.1186/s12885-020-06897-z.
Dear friends, dear colleagues
A few weeks ago, we announced that we were continuing to work on EANO 2020, hoping that by September 2020 the circumstances would allow this major European neuro-oncological event to happen. However, it is clear that even now when restrictions are gradually lifted many uncertainties about the COVID infection rate will remain over the entire summer period. Unpredictable travel limitations, unclear national policies on mass gatherings, and the chance of yet another surge in COVID infections make a productive and successful face-to-face EANO 2020 in early September unlikely. Therefore, we have taken the difficult decision to postpone the EANO 2020 Meeting in Glasgow to another year.
We have decided to develop a series of webinars instead, called eEANO, through which we will bring neuro-oncological updates to the EANO membership. These will start on September 10-13, the original dates of EANO 2020. We will continue eEANO as a series of webinars afterwards, which will be CME credited, for members only. We intend to provide both educational content and the latest scientific developments on clinical trials and laboratorial research as a continuing programme. Topics will be developed in collaboration with the membership. More information will be provided once we have finalized the details. The next planned EANO Meeting should take place in 2021. We will keep you posted on that situation and very much hope to welcome you to a ‘face-to-face’ conference next year.
I am very sorry not to see you in person in Glasgow this summer; not meeting colleagues is yet another loss that many of us deplore. I also apologize for not informing you earlier, but as you can imagine it has been complicated to reach a good solution with regard to the practical issues. Lastly, I want to recognize the many people who have worked hard to prepare the 2020 meeting, in particular our local chair Anthony Chalmers. EANO is scheduled to come to Glasgow in 2024!
On behalf of the EANO board,
Martin van den Bent
The EANO Executive Board is glad to present this year's EANO Annual Report. It gives you an overview on what we have done during 2019 and on our planned activities for 2020 as well as important developments in Neuro-Oncology in Europe.
For the new EANO Annual Report 2019 click here
According to the EANO Youngsters
The EANO Youngsters selected the most important scientific neuro-oncology papers of 2019. Instead of just looking at the number of citations or impact factors, we performed a survey in our EANO Youngsters Facebook group. We received a lot of input! We now have an interesting impression of which studies our followers were most interested in this year.
This year's list features important basic science papers, published in high-impact journals, and possible practice-changing clinical papers.
So, here are our top 6 paper:
- Suva group's single cell paper: Neftel C. et al. (2019) An Integrative Model of Cellular States, Plasticity, and Genetics for Glioblastoma. Cell, 178(4):835-849.e21. doi: 10.1016/j.cell.2019.06.024. https://www.ncbi.nlm.nih.gov/pubmed/31327527
- The Nature-trio on synaptic interactions between glioma cells and neurons: Barrier A. Dangerous liaisons as tumour cells form synapses with neurons. Nature (2019) 573, 499-501, doi: 10.1038/d41586-019-02746-7 https://www.nature.com/articles/d41586-019-02746-7
- Taylor group's snRNA paper: Suzuki H. et al. . Recurrent non-coding U1-snRNA mutations drive cryptic splicing in Shh medulloblastoma. Nature. (2019). doi: 10.1038/s41586-019-1650-0. https://www.ncbi.nlm.nih.gov/pubmed/31597162
- Exciting work from the Glioma Longitudinal Analysis (GLASS) Consortium: Barthel, F.P., Johnson, K.C., Varn, F.S. et al. Longitudinal molecular trajectories of diffuse glioma in adults. Nature (2019) doi:10.1038/s41586-019-1775-1 https://www.nature.com/articles/s41586-019-1775-1
- Whole brain radiotherapy with or without hippocampal avoidance in brain metastases: Tomé W. et al. RADI-11. NRG ONCOLOGY CC001: A PHASE III TRIAL OF HIPPOCAMPAL AVOIDANCE IN ADDITION TO WHOLE-BRAIN RADIOTHERAPY (WBRT) PLUS MEMANTINE TO PRESERVE NEUROCOGNITIVE FUNCTION IN PATIENTS WITH BRAIN METASTASES (BM), Neuro-Oncology Advances, Volume 1, Issue Supplement_1, August 2019, Pages i23–i24, doi.org/10.1093/noajnl/vdz014.104 https://academic.oup.com/noa/article/1/Supplement_1/i23/5546283
- Lomustine-temozolomide or standard temozolomide therapy in glioblastoma: Herrlinger U. et al. Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA–09): a randomised, open-label, phase 3 trial. The Lancet (2019) 393 (10172), P678-688, doi.org/10.1016/S0140-6736(18)31791-4 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31791-4/fulltext?dgcid=raven_jbs_etoc_email
Dear friends and colleagues,
It was a great pleasure to welcome all of you in Lyon, and make the EANO 2019 a great meeting increasing our knowledge to take care of patients with brain tumors. More than 750 participants from 50 different countries and from all the continents participated to the 14th EANO meeting. All the specialties were equally represented with a good percentage of nurses. The scientific presentations showed up a large variety of important subjects in the field of neuro-oncology and was the opportunity to listen to high level lectures about immunology, low-grade glioma, omics in neuro-oncology, microenvironment, neurological complications of cancer or brain lymphoma. It was also wonderful to see the involvement of young neuro-oncologists in the EANO meeting and organization. The diversity of age and origin of the participants is really a good sign that EANO annual meetings have become a meeting for everybody and able to attract colleagues from all continents.
The 14th EANO meeting was also the opportunity to discover Lyon, a European city at the crossroads of Europe, listed by UNESCO as a world heritage site with the remains of 20 centuries of History. The participants discovered the high level of gastronomy of the city with its 14 starred restaurants and to the typical and charming bistros called “Bouchons”. The networking evenings have been the opportunity to visit the City Hall and to have a wonderful cruse with a seated dinner on the Rhone and the Saone.
We were very happy when France and Lyon were given the responsibility for EANO 2019, and it has been a real pleasure to interact with all the members of the EANO executive Board and the EANO scientific committee to construct the program and to organize the meeting.
Many thanks for your contribution and I will be very happy to meet you in Glasgow in September 2020.
Jérôme Honnorat, President EANO 2019 Meeting
EANO members can find a large selection of presentations from the EANO 2019 Meeting online in the login area!
The European Association of Neuro-Oncology (EANO) and Society for NeuroOncology (SNO) the are pleased to announce that their journal, Neuro-Oncology Practice, is now fully indexed in PubMed Central® (PMC). All content published in Neuro-Oncology Practice, starting with the first issue, has been deposited in PMC and is now discoverable through PubMed®. PMC is a free archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM).
Indexing in PMC and discoverability via PubMed provides increased access to articles for the scientific and clinical communities, and marks its continued success, high-quality articles, and the diversity and excellence of the editorial board and authors. The Journal can be accessed here: https://academic.oup.com/nop (includes Advance Access articles), and can also be accessed on the PMC site here: https://www.ncbi.nlm.nih.gov/pmc/journals/2697/
“It has been great to partner with SNO, EANO and OUP to grow the journal and provide the neuro-oncology community with valuable resources pertinent to patient care,” said Dr Susan Chang, Editor in Chief of Neuro-Oncology Practice and Professor of Neurological Surgery at the University of San Francisco, CA, United States, “I know authors and readers will be happy that articles from Neuro-Oncology Practice will be discoverable via PubMed.”
Published in partnership with Oxford University Press, Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice.
For more information and to submit a manuscript for consideration, visit https://academic.oup.com/nop and follow the journal via Twitter at https://twitter.com/neuroonc and at https://twitter.com/eanoassociation