Abstract Details

Title Large Retrospective Institutional Review Identifies Novel Integrated Imaging and Clinical Markers as Early Independent Negative Prognostic Indicators of Glioblastoma Progression and Survival: A Proposed Supplement to RANO

Topic Neuro-oncology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 13-001

Objective

Glioblastoma (GBM) is the deadliest adult primary brain tumor with an overall survival (OS) around 15 months and virtually inevitable sooner tumor progression.

Background

Delays in identifying progressive GBM risks neurologic decline, continuation of ineffective therapies, and increased tumor resistance to second-line treatments. Improved confidence in determining tumor progression is an active topic in our field and available response criteria remains unvalidated.

Design/Methods We evaluated 622 pathology confirmed GBM (2006–2019) including radiographic, clinical, and pathomolecular data to identify integrated early indicators of progressive GBM. T2/FLAIR hyperintensity (HrI) and T1 contrast enhancement within and around the resection cavity (RC) were evaluated in over 2,000 MRIs. Clinical scores using Neurologic Assessment in Neuro-Oncology (NANO) at time-points prior to RCHrI, at time of RCHrI, and at time of RANO clinical progression were obtained. T2/FLAIR intensity in the RC was quantified using specialized imaging software. We further evaluated relationships between HrI and MGMT methylation status, MIB (high >30/low <30), time to HrI from diagnosis, time to progression (TTP), and OS.

Results Total 153 cases included fit the rigorous criteria, 132 had progression; 98 (74%) had positive HrI and 34 patients (26%) had no HrI prior to RANO progression. HrI development was associated with lower mean TTP (11.7mos vs 14mos) and mOS (19 vs 24mos), and higher NANO score. HrI was a poor prognostic indicator within the MGMT methylated group. Mean TTP after HrI development was 3.4 months.

Conclusions

This two-phased retrospective/prospective validation study identifies RCHrI as an independent negative prognostic indicator in GBM with novel integration of clinical and pathomolecular markers offering a 3.4 month window for therapeutic intervention prior to RANO progression. A multicentered prospective interventional clinical trial to test this has been submitted for formal review. There is also potential significance for concurrent validation of RANO and NANO as part of the prospective study.

Authors/Disclosures
Na Tosha N. Gatson, MD, PhD, FAAN PRESENTER	Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GT Medical Technologies. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Menarini Silicon Biosystems. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NuvOx Pharmaceuticals. Dr. Gatson has received publishing royalties from a publication relating to health care. Dr. Gatson has a non-compensated relationship as a Board Member with Society for Equity in Neurosciences (SEQUINS) that is relevant to AAN interests or activities.
Shane Bross	No disclosure on file
Vinaykumar Puduvalli, MD (The University of Texas MD Anderson Cancer Center)	Dr. Puduvalli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Insightec . Dr. Puduvalli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novocure. Dr. Puduvalli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. An immediate family member of Dr. Puduvalli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Newave . Dr. Puduvalli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier. Dr. Puduvalli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Insightec, Novocure, Bayer, Servier, . An immediate family member of Dr. Puduvalli has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Newave . Dr. Puduvalli has stock in Gilead. Dr. Puduvalli has stock in Moderna. The institution of Dr. Puduvalli has received research support from Merck, Servier, Bexion, Karyopharm, Samus therapeutics.
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