to book your place for the first eEANO webinars:
EANO webinar Tumorboard 2, November 4, 2020 16:00-17:30 (CEST) (NO CME!)
Case 1 - How to treat a patient with brain metastases? George Petrescu, Bucharest, RO
Case 2 - How to treat a patient with leptomeningeal metastases? Alessia Pellerino, Torino, IT
Neuropathology: Sebastian Brandner, London/UK
Neurosurgery: Marike Broekman, The Hague/NL
Radiology: Anna Falk Delgado, Stockholm/SE
Radio-Oncology: Frédéric Dhermain, Villejuif/FR
Oncology: Matthias Preusser, Vienna/AT
EANO webinar November 18, 2020, taking a break due to SNO annual conference (this time virtual)
EANO webinar on novel insights on hypermutated IDH mutated gliomas and temozolomide treatment of IDHwt astrocytoma December 2, 2020 16:00-17:30 (CET)
EANO webinar on EANO Guidelines December 16, 2020 16:00-17:30 (CET)
⇒Click here to book you place!
Further eEANO webinars to come!
Are there any sessions you would really like to be part of the programme? Have you recently been thoroughly impressed by one or more speakers you have seen at a meeting, both in terms of being an excellent speaker and presenting excellent science?
We call for proposal for the programme for the EANO 2021 meeting. The EANO board and Scientific committee are currently developing an exciting and multidisciplinary programme, and would appreciate your input!
We are looking forward to receiving your suggestions on clinical and basic science sessions! Please suggest 4 speakers and consider diversity and balance in terms of junior and senior, gender and country representation)
Please submit your proposal until November 1, 2020 submission
We would like to thank you in advance for your input, and hope to welcome you in Rotterdam in September 2021!
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.
Thank you for your participation!
Click here for participation
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