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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. 2019-2019
    Abstract: 2019 Background: Glioblastoma (GBM) is the most frequent, lethal primary brain tumor in adults. Patients harboring tumors with functional O6 methylguanine DNA methyltransferase ( MGMT) DNA enzyme gain limited benefit from temozolomide therapy. As shown in preclinical studies, bortezomib depletes the MGMT enzyme, restoring the tumor ́s susceptibility to temozolomide, if administered in a precise schedule when the MGMT enzyme is depleted. We hypothesized that recurrent GBM patients with unmethylated MGMT promoter may obtain clinical benefit from sequential BTZ and TMZ treatment. Methods: BORTEM-17 is a multicenter, open label, single arm, non-randomized phase IB/II trial to investigate potential survival benefit for recurrent glioblastoma patients administered bortezomib 48hrs prior to temozolomide. Sample size is calculated to 63 patients, of whom 10 included in phase IB. The doses of bortezomib is 1.3mg/m2 intravenously days 1, 4, and 7 during 4-week cycle, and temozolomide 200mg/m2 days 5-7. The control group is a retrospective cohort of 467 patients treated at 2 referral hospitals in Norway from January 2015 to December 2017. For the survival analysis, the patients included in BORTEM-17 (n=44) were compared with MGMT unmethylated control, age matched patients (n=116). The pre-defined interim analysis was performed after inclusion of 15 patients and as more than 2 of 15 patients had clinical benefit, the study was continued. Results: Until January 2023, 44 patients with median age 55 years (range 25-69), 30 males and 14 females were treated. Median KPS was 90 (70-100) and median NANO score 1 (0-7). The interim analysis was performed after inclusion of 15 patients in the phase IB and II and clinical benefit was observed in 5 patients. Two of them had tumor volume reduction and three experienced stable disease. The study proceeded to the next step. No treatment related deaths were observed. The most common adverse effects included hematological toxicity, gastrointestinal symptoms, muscle weakness, lower back pain and fatigue. Patients that progressed during the BORTEM-17 trial and were fit for further therapy received treatment at their physician’s discretion. The preliminary data analysis after 44 of planned 63 patients were treated indicate prolonged median survival for BORTEM-17 patients 19.0 months vs 12.2 months of control MGMT unmethylated age matched patients. Median survival after recruitment is 5.5 months (1.0-23.8). Conclusions: The sequential BTZ+TMZ therapy is safe, feasible and effective as indicated by preliminary data when 70% of planned MGMT unmethylated patients have been included. Preliminary data indicate that the combination of BTZ and TMZ may offer an additional line of treatment with limited toxicity to the group of patients with particularly dismal prognosis. Clinical trial information: NCT03643549 .
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2010
    In:  Molecular Cancer Vol. 9, No. 1 ( 2010), p. 135-
    In: Molecular Cancer, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2010), p. 135-
    Type of Medium: Online Resource
    ISSN: 1476-4598
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2010
    detail.hit.zdb_id: 2091373-4
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  • 3
    In: BioMed Research International, Hindawi Limited, Vol. 2013 ( 2013), p. 1-9
    Abstract: Object . Gamma knife surgery (GKS) may be used for recurring glioblastomas (GBMs). However, patients have then usually undergone multimodal treatment, which makes it difficult to specifically validate GKS independent of established treatments. Thus, we developed an experimental brain tumor model to assess the efficacy and radiotoxicity associated with GKS. Methods . GBM xenografts were implanted intracerebrally in nude rats, and engraftment was confirmed with MRI. The rats were allocated to GKS, with margin doses of 12 Gy or 18 Gy, or to no treatment. Survival time was recorded, tumor sections were examined, and radiotoxicity was evaluated in a behavioral open field test. Results . In the first series, survival from the time of implantation was 96 days in treated rats and 72 days in controls ( P 〈 0.001 ). In a second experiment, survival was 72 days in the treatment group versus 54 days in controls ( P 〈 0.006 ). Polynuclear macrophages and fibrosis was seen in groups subjected to GKS. Untreated rats with GBM xenografts displayed less mobility than GKS-treated animals in the open field test 4 weeks after treatment ( P = 0.04 ). Conclusion . GKS administered with clinically relevant doses prolongs survival in rats harboring GBM xenografts, and the associated toxicity is mild.
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2013
    detail.hit.zdb_id: 2698540-8
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  • 4
    In: Immunology, Wiley, Vol. 131, No. 3 ( 2010-11), p. 386-394
    Type of Medium: Online Resource
    ISSN: 0019-2805
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2006481-0
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  • 5
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2013
    In:  Cancer Research Vol. 73, No. 8_Supplement ( 2013-04-15), p. LB-332-LB-332
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 73, No. 8_Supplement ( 2013-04-15), p. LB-332-LB-332
    Abstract: Glioblastoma (GBM) is the most malignant and frequent brain tumor. Despite combined surgery, chemo- and radiotherapy, GBM patients' survival remains very low, emphasizing the need for further development of novel therapies. The promising strategy is adoptive cellular immunotherapy. Studies investigating purified Natural Killer (NK) cells in adoptive transfer therapies for solid tumors are sparse. Most clinical trials in GBM patients have used Lymphokine Activated Killer (LAK) cells that are composed of T-lymphocytes and NK cells, where the former can contribute to Graft vs Host Disease (GvHD) and inhibit NK cytotoxicity. We hypothesized that purified allogeneic NK cells may be potent effectors for adoptive transfer in GBM patients due to their cytotoxicity, cytokine production and immunomodulatory properties. We performed in vitro cytotoxicity experiments using patient-derived GBM cells co-cultured with resting or ex vivo expanded and activated NK cells isolated from healthy donors or LAK cells derived from the same donors. We also investigated the role of Killer Immunoglobulin-like Receptor (KIR) versus Human Leucocyte Antigen (HLA) ligand mismatch in determining potency of NK cell-mediated cytotoxicity in vitro and in vivo in human GBM-bearing Nod-Scid mice, treated with activated human NK cells isolated from 2 different donors with or without KIR-HLA ligand mismatch. The primary end points were animals' survival, NK persistence in vivo and mechanisms of therapeutic efficacy. All GBM tumors investigated for cytotoxicity expressed variable levels of MHC class I, MICA/B, ULBP1-3 as evaluated by flow cytometry. High resolution HLA-typing of the GBM cells and KIR-typing of donors was performed at genomic level. Resting and activated NK cells were also characterized for expression levels of NKp46, NKG2D/A and KIRs by flow cytometric phenotyping. Activated NK cells killed GBM cells more efficiently than resting NK cells and LAK cells in a dose- and donor-dependent manner. By examining tumor-donor pairs for KIR-HLA ligand mismatch we could identify the receptor-ligand combinations that determine greater cytotoxic potential in vitro in suspension cultures vs. in vivo in solid tumors in mice. We demonstrate that KIR-HLA ligand mismatch was important in killing the GBM cells by resting NK cells, however, the cytotoxicity mediated by activated NK cells was less dependent on KIR-HLA mismatch. Activated NK cells upregulated expression of particular KIRs when compared to resting NK cells from the same donor and this partially explains why activated NK cell - mediated cytotoxicity is less dependent on KIR-HLA ligand mismatch. We conclude that purified and activated NK cells are better effectors against gliomas than LAK cells. However, the KIR-HLA mismatch in solid tumors may not be the primary determinant of activated NK potency in vitro but may have relevance in vivo. Citation Format: Justyna Kmiecik, Andrea Gras Navarro, Per Ø. Enger, Mateusz Zelkowski, Jacques Zimmer, Martha Chekenya Enger. Purified ex vivo expanded and activated human Natural Killer cells efficiently kill glioblastoma cells in a dose- and donor-dependent manner. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-332. doi:10.1158/1538-7445.AM2013-LB-332 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2013
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 6
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 71, No. 8_Supplement ( 2011-04-15), p. 528-528
    Abstract: Background: The tumor microenvironment is increasingly recognized as pivotal in tumor progression. Thus, by completely separating tumor cells from stromal cells it enables a thorough elucidation of gene-changes in the two compartments, and thereby offers the possibility to better understand the biological effects in tumors with and without treatment. Since tumor hypoxia is considered to be relevant for several aspects of tumor pathophysiology, including activation of signalling pathways that regulate proliferation, angiogenesis and death, our hypothesis was that a reduction in the hypoxic state of the tumor, might have an inhibitory effect on tumor growth per se. Induction of hyperoxia by hyperbaric oxygen (HBO) exposure, enhance dissolved oxygen in the plasma and thereby the pO2 in the tumor tissue. Methods: The murine mammary dsRed cell line 4T1 was implanted into the mouse mammary fat pad in eGFP expressing NOD/Scid mice. One group was exposed to repeated HBO treatment (2.5 bar, 100% O2, 3 exposures à 90 min), one to daily HBO treatment (2.5bar, 100% O2, 7 exposures à 90 min), whereas the control group was housed under normal atmosphere. Treatment effects were determined by assessment of tumor growth, tumor vascularisation, tumor cell proliferation and cell death. FACS was used to completely separate red tumor cells from green host cells, RNA was extracted and gene expression profiling performed. Results: The model enabled us to completely separate the two compartments (tumor vs stroma), as verified by confocal microscopy and gene expression profiling. Highly upregulated genes in the untreated tumor stroma, included constituents of the ECM and MMP's, as well as genes related to cell-migration and motility. Significant changes in response to treatment between the tumor and stroma was found, especially concerning genes related to cell adhesion and angiogenesis. Furthermore, changes occurring within each of these compartments were found. Tumor growth was significantly inhibited (∼ 50%, after 8 days) after both repeated and daily HBO treatment compared to controls. Repeated HBO treatment showed a significant anti-angiogenic effect, while daily HBO treatment did not. The gene expression confirmed this. Neither morphology, proliferation nor the amount of cell death was significantly changed after the two HBO treatment regimes, despite the significant effect on tumor growth. Conclusion: The present model provides a significant insight into how tumor cells communicate with the stroma, both before any treatment and after enhanced oxygenation. Furthermore, hyperoxia induced a significant inhibitory effect on the 4T1 mammary tumor growth, with a significant anti-angiogenic effect after repeated hyperoxic treatment. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 528. doi:10.1158/1538-7445.AM2011-528
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
    RVK:
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2011
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 7
    In: Acta Neuropathologica, Springer Science and Business Media LLC, Vol. 122, No. 4 ( 2011-10), p. 495-510
    Type of Medium: Online Resource
    ISSN: 0001-6322 , 1432-0533
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
    detail.hit.zdb_id: 1458410-4
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  • 8
    Online Resource
    Online Resource
    The American Association of Immunologists ; 2013
    In:  The Journal of Immunology Vol. 190, No. 11 ( 2013-06-01), p. 5355-5362
    In: The Journal of Immunology, The American Association of Immunologists, Vol. 190, No. 11 ( 2013-06-01), p. 5355-5362
    Abstract: NK cells are important players in immunity against pathogens and neoplasms. As a component of the innate immune system, they are one of the first effectors on sites of inflammation. Through their cytokine production capacities, NK cells participate in the development of a potent adaptive immune response. Furthermore, NK cells were found to have regulatory functions to limit and prevent autoimmunity via killing of autologous immune cells. These paradoxical functions of NK cells are reflected in CNS disorders. In this review, we discuss the phenotypes and functional features of peripheral and brain NK cells in brain tumors and infections, neurodegenerative diseases, acute vascular and traumatic damage, as well as mental disorders. We also discuss the implication of NK cells in neurotoxicity and neuroprotection following CNS pathology, as well as the crosstalk between NK cells and brain-resident immune cells.
    Type of Medium: Online Resource
    ISSN: 0022-1767 , 1550-6606
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    Language: English
    Publisher: The American Association of Immunologists
    Publication Date: 2013
    detail.hit.zdb_id: 1475085-5
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  • 9
    Online Resource
    Online Resource
    MDPI AG ; 2021
    In:  Cancers Vol. 13, No. 19 ( 2021-10-05), p. 4986-
    In: Cancers, MDPI AG, Vol. 13, No. 19 ( 2021-10-05), p. 4986-
    Abstract: Glioblastoma (GBM) is the most prevalent, aggressive primary brain tumour with a dismal prognosis. Treatment at diagnosis has limited efficacy and there is no standardised treatment at recurrence. New, personalised treatment options are under investigation, although challenges persist for heterogenous tumours such as GBM. Gene editing technologies are a game changer, enabling design of novel molecular-immunological treatments to be used in combination with chemoradiation, to achieve long lasting survival benefits for patients. Here, we review the literature on how cutting-edge molecular gene editing technologies can be applied to known and emerging tumour-associated antigens to enhance chimeric antigen receptor T and NK cell therapies for GBM. A tight balance of limiting neurotoxicity, avoiding tumour antigen loss and therapy resistance, while simultaneously promoting long-term persistence of the adoptively transferred cells must be maintained to significantly improve patient survival. We discuss the opportunities and challenges posed by the brain contexture to the administration of the treatments and achieving sustained clinical responses.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2527080-1
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  • 10
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 5, No. 1 ( 2023-01-01)
    Abstract: Tumor burden assessment is essential for radiation therapy (RT), treatment response evaluation, and clinical decision-making. However, manual tumor delineation remains laborious and challenging due to radiological complexity. The objective of this study was to investigate the feasibility of the HD-GLIO tool, an ensemble of pre-trained deep learning models based on the nnUNet-algorithm, for tumor segmentation, response prediction, and its potential for clinical deployment. Methods We analyzed the predicted contrast-enhanced (CE) and non-enhancing (NE) HD-GLIO output in 49 multi-parametric MRI examinations from 23 grade-4 glioma patients. The volumes were retrospectively compared to corresponding manual delineations by 2 independent operators, before prospectively testing the feasibility of clinical deployment of HD-GLIO-output to a RT setting. Results For CE, median Dice scores were 0.81 (95% CI 0.71–0.83) and 0.82 (95% CI 0.74–0.84) for operator-1 and operator-2, respectively. For NE, median Dice scores were 0.65 (95% CI 0.56–0,69) and 0.63 (95% CI 0.57–0.67), respectively. Comparing volume sizes, we found excellent intra-class correlation coefficients of 0.90 (P & lt; .001) and 0.95 (P & lt; .001), for CE, respectively, and 0.97 (P & lt; .001) and 0.90 (P & lt; .001), for NE, respectively. Moreover, there was a strong correlation between response assessment in Neuro-Oncology volumes and HD-GLIO-volumes (P & lt; .001, Spearman’s R2 = 0.83). Longitudinal growth relations between CE- and NE-volumes distinguished patients by clinical response: Pearson correlations of CE- and NE-volumes were 0.55 (P = .04) for responders, 0.91 (P & gt; .01) for non-responders, and 0.80 (P = .05) for intermediate/mixed responders. Conclusions HD-GLIO was feasible for RT target delineation and MRI tumor volume assessment. CE/NE tumor-compartment growth correlation showed potential to predict clinical response to treatment.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3009682-0
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