Survival Of GBM Patients Research Articles

The role of PDCD6 in stemness maintenance of Glioblastoma

BackgroundGlioblastoma (GBM) poses formidable challenges due to its high malignancy and therapeutic resistance and still exhibits dismal 5-year survival rates, high recurrence propensity, and limited treatment modalities. There is an acute need for innovative treatments for recurrent glioblastoma due to the lack of established protocols. This necessity is driving research into the cellular underpinnings that initiate and drive the disease forward, aiming to discover groundbreaking targets for therapy that could enhance the efficacy of medical interventions. MethodsPatient-derived glioblastoma stem cells (GSCs) were harvested and isolated. Subsequently, PDCD6 expression was quantified through both western blotting (WB) and real-time PCR (RT-PCR) techniques. The stem-like properties of the GSCs were evaluated using sphere-forming assays. All gathered data, inclusive of TCGA datasets, were analyzed using SPSS (IBM) version 23.0. ResultsElevated PDCD6 expression characterized classical GBM tumor tissues. PDCD6 overexpression significantly correlated with diminished overall survival in GBM patients, emerging as an independent prognostic indicator. Notably, primary GBM cells exhibited heightened PDCD6 levels in GSCs compared to NSTCs. Moreover, alterations in stemness markers paralleled PDCD6 modulation, where PDCD6 knockdown attenuated tumor size in GSCs. ConclusionOur findings illuminate PDCD6's role in fostering stemness within classical GBM, hinting at its potential as a therapeutic target.

BIOM-27. VOXEL-WISE SURVIVAL ANALYSIS IN GLIOBLASTOMA: TUMOR PROBABILITY MAPS REVEAL CRITICAL REGIONS NEAR WHITE MATTER TRACTS

Abstract BACKGROUND Glioblastoma is the most aggressive primary brain tumor, characterized by rapid growth and poor prognosis. Understanding spatial determinants of survival in GBM is crucial for improving prognostic accuracy and treatment strategies. Our study employs voxel-wise survival analysis (VSA) of tumor probability maps (TPMs) derived from MRI to identify high-risk brain regions. TPMs are generated through radio-pathomic mapping and can predict non-enhancing tumor regions not captured by traditional imaging. We aim to determine if high tumor probability regions are near previously identified critical white matter (WM) tracts and assess their impact on survival outcomes. METHODS We analyzed data from 374 GBM patients from the UCSF-PDGM-v2 dataset. Using a pretrained radio-pathomic model, TPMs were predicted based on T1, T1C, ADC, and FLAIR MRI sequences. All TPMs were rigidly registered to MNI space using ANTs. A Cox proportional hazards model was applied voxel-wise to assess the association between tumor probability and overall survival (OS). A p-value map was generated, thresholded, and cluster corrected (p < 0.05) for further analysis. RESULTS The VSA revealed that high tumor probability regions were significantly associated with poorer OS in GBM. Gray matter (GM) regions near WM tracts with high tumor probability showed markedly reduced survival. GM regions adjacent to the left IFOF (p < 0.05, HR = 1.19, 845 vs. 961 days for high/low TPM), Corpus Callosum Forceps Minor (p = 0.0001, HR = 1, 740 vs. 902 days), Body of the Corpus Callosum (p = 0.005, HR = 0.97, 748 vs. 798 days for high/low TPM) and other WM tracts, such as the left thalamic radiation superior and left reticulospinal tracts had similar trends. CONCLUSIONS Our study demonstrates that regions with high tumor probability, particularly those in the GM near critical WM tracts, are strongly associated with worse overall survival in GBM patients.

Analysis of IDH and EGFR as biomarkers in glioblastoma multiforme: A case-control study

BackgroundGlioblastoma multiforme (GBM) is a very aggressive primary central nervous system (CNS) tumor with limited therapeutic options and poor prognosis. This study aimed to analyze the association between single nucleotide polymorphisms (SNPs), including IDH1 rs121913500C > T, IDH2 rs11540478G > A, and EGFR rs1468727C > T, and their association on the risk and overall survival of GBM patients in Jordan. MethodsUsing a case-control study design involving 63 GBM patients and 226 healthy controls was conducted at King Abdullah University Hospital in Jordan. DNA extraction was performed using formalin-fixed and paraffin-embedded tissue for GBM samples and blood samples for controls. SNPs analysis was performed using the Sequenom iPLEX assay sequencing technique. Survival outcomes were assessed using Cox models and hazard ratios (HR), and single-cell RNA (scRNA) analysis was performed from GSE70630. ResultsThe study showed a significant association between genotype frequency in GBM cases and controls for specific SNPs, including IDH1 rs121913500C > T, and EGFR rs1468727C > T. The G/G genotype of rs11540478 (IDH2) was associated with better prognostic outcomes in GBM patients. The scRNA analysis demonstrated the differential expression of IDH1, IDH2, and EGFR in GBM, with enrichment in central carbon metabolism in cancer. ConclusionOur findings suggest that SNPs, particularly in IDH1 and IDH2 genes and EGFR, may serve as diagnostic and prognostic biomarkers for GBM. While the study underscores the clinical relevance of these genetic variants, further investigations with larger and more diverse populations are essential to validate and extend these associations.

Unveiling novel cell clusters and biomarkers in glioblastoma and its peritumoral microenvironment at the single-cell perspective

BackgroundGlioblastoma (GBM) is a highly heterogeneous, recurrent and aggressively invasive primary malignant brain tumor. The heterogeneity of GBM results in poor targeted therapy. Therefore, the aim of this study is to depict the cellular landscape of GBM and its peritumor from a single-cell perspective. Discovering new cell subtypes and biomarkers, and providing a theoretical basis for precision therapy.MethodsWe collected 8 tissue samples from 4 GBM patients to perform 10 × single-cell transcriptome sequencing. Quality control and filtering of data by Seurat package for clustering. Inferring copy number variations to identify malignant cells via the infercnv package. Functional enrichment analysis was performed by GSVA and clusterProfiler packages. STRING database and Cytoscape software were used to construct protein interaction networks. Inferring transcription factors by pySCENIC. Building cell differentiation trajectories via the monocle package. To infer intercellular communication networks by CellPhoneDB software.ResultsWe observed that the tumor microenvironment (TME) varies among different locations and different GBM patients. We identified a proliferative cluster of oligodendrocytes with high expression of mitochondrial genes. We also identified two clusters of myeloid cells, one primarily located in the peritumor exhibiting an M1 phenotype with elevated TNFAIP8L3 expression, and another in the tumor and peritumor showing a proliferative tendency towards an M2 phenotype with increased DTL expression. We identified XIST, KCNH7, SYT1 and DIAPH3 as potential factors associated with the proliferation of malignant cells in GBM.ConclusionsThese biomarkers and cell clusters we discovered may serve as targets for treatment. Targeted drugs developed against these biomarkers and cell clusters may enhance treatment efficacy, optimize immune therapy strategies, and improve the response rates of GBM patients to immunotherapy. Our findings provide a theoretical basis for the development of individualized treatment and precision medicine for GBM, which may be used to improve the survival of GBM patients.

LTF as a Potential Prognostic and Immunological Biomarker in Glioblastoma.

The lactoferrin (LTF) gene behaves like a tumor suppressor gene in diverse tumors, such as renal cancer, nasopharyngeal carcinoma and gastric cancer. However, the prognostic value of LTF expression in patients with glioblastoma remains unclear. In this study, the expression levels of LTF in patients with GBM were investigated in TCGA, GEPIA, CGGA and GEO database, and a survival analysis of LTF based on TCGA and CGGA was performed. Furthermore, the present study demonstrated the LTF gene co-expression, PPI network, KEGG/GO enrichment and immune cell infiltration analysis on TCGA and TIMER2.0 database. We found that LTF expression was significantly upregulated in GBM samples compared with normal samples and other glioma samples, and Kaplan-Meier analysis demonstrated that the overexpression of LTF were significantly associated with worse overall survival (OS) and 5-year OS in GBM patients (P < 0.05). KEGG/GO enrichment analysis demonstrated that functions of LTF concentrated in immune and inflammatory response and peptidase regulation (P < 0.05). Immune cell infiltration analysis presented that high LTF expression exhibited dysregulated immune infiltration (i.e., CD4 + T cells, neutrophils, macrophages, myeloid dendritic cells and cancer associated fibroblast). LTF was upregulated in tumors and correlated with worse OS in GBM patients, and LTF might function as an oncogene via inducing dysregulated immune infiltration in GBM.

Abstract LB323: Deciphering the immunomodulatory role of IL-19 in glioblastoma-promoting ecosystem: Insights into glioblastoma stem cell-tumor-associated macrophage symbiosis

Abstract Glioblastoma multiforme (GBM) stands out as a highly aggressive and resistant brain tumor, characterized by profound immunosuppression and chemoresistance, resulting in a dismal 5% survival rate at the five-year mark. Glioblastoma Stem Cells (GSCs) drive the progression of GBM, orchestrating tumor initiation, growth, and therapeutic resistance. The symbiotic interplay between GSCs and tumor-associated macrophages (TAMs) within hypoxic and perivascular niches is pivotal for sustaining tumorigenesis and immunosuppression. In this study, Interleukin-19 (IL-19), a member of the IL-10 family, was identified among the top five immune-related genes strongly associated with poor survival in patients with GBM from TCGA and Taiwan GBM cohorts. However, the function of IL-19 in glioblastoma is completely unknown. Genomic screening identified IL-19 as a predicted immunosuppressive cytokine in the peritumoral region, associated with poor survival in GBM patients. Blocking IL-19 inhibits both temozolomide (TMZ)-sensitive and TMZ-resistant tumor progression. Molecular studies revealed that IL-19 promotes TMZ-resistant GBM cell migration and invasion through a novel IL-19/β-catenin/WISP1 signaling. Single-cell transcriptome analysis showed that blocking IL-19 promotes T cell activation, upregulates the effector function of T cell subsets, and reprograms TAM subsets toward weakened pro-tumoral phenotypes with lower Arginase 1 expression. Silencing IL-19 significantly disrupts self-renewal GSC activity through a novel IL-19/S100A4/WISP1 signaling. Additionally, we identified that TAM-derived IL-19 positively regulates GSC self-renewal through the paracrine IL-19/WISP1 axis. Our study demonstrates IL-19 as a linchpin in the complex GSC-TAM symbiosis, leading to GSC maintenance and immunosuppression, providing critical insights into the immune landscape orchestrated by GSC-TAM symbiosis Citation Format: Gilbert Aaron Lee, Cheng-Yu Chen. Deciphering the immunomodulatory role of IL-19 in glioblastoma-promoting ecosystem: Insights into glioblastoma stem cell-tumor-associated macrophage symbiosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB323.

Abstract 516: The role of clathrin-mediated endocytosis of EGFR in glioblastoma cell viability and cell cycle progression

Abstract Glioblastoma (GBM) is characterized by poor prognosis and overexpression of epidermal growth factor receptor (EGFR). EGFR signaling is regulated through endocytosis, including clathrin-mediated endocytosis. We hypothesized that clathrin-mediated EGFR endocytosis promotes GBM cell viability and proliferation. Analysis of patient data from the Gliovis database revealed decreased overall survival in GBM patients with above-median clathrin expression (n=262) compared to below-median expression (n=263, p&amp;lt;0.05). Immunocytochemistry and Western blot analysis confirmed increased clathrin levels in GBM patient samples compared to normal brain tissue (n=15, p&amp;lt;0.01). To determine the functional effect of inhibiting clathrin-mediated endocytosis, U87 and U251 GBM cells were treated with 15 μM Pitstop-2, a clathrin inhibitor, for 24 hours. Pitstop-2 significantly reduced clathrin levels and cell viability by 40% compared to control (p&amp;lt;0.001, n=3). Cell cycle analysis by flow cytometry revealed Pitstop-2 treatment led to G2/M arrest in both cell lines versus control (p&amp;lt;0.01, n=3). Together, these findings indicate clathrin-mediated endocytosis of EGFR may promote GBM cell viability and proliferation. Further studies on the effects of clathrin inhibition on EGFR signaling and tumor growth in vivo will elucidate the therapeutic potential of targeting this pathway. Citation Format: Aaron Deter, Andrew J. Tsung, Maheedhara R. Guda, Swapna Asuthkar, Kiran Velpula. The role of clathrin-mediated endocytosis of EGFR in glioblastoma cell viability and cell cycle progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 516.

Multi-omics analysis of TLCD1 as a promising biomarker in pan-cancer.

Background: The TLC Domain Containing 1 (TLCD1) protein, a key regulator of phosphatidylethanolamine (PE) composition, is distributed across several cellular membranes, including mitochondrial plasma membranes. Existing research has revealed the impact of TLCD1 on the development of non-alcoholic fatty liver disease. However, there remains a gap in comprehensive pan-cancer analyses of TLCD1, and the precise role of TLCD1 in cancer patient prognosis and immunological responses remains elusive. This study aims to provide a comprehensive visualization of the prognostic landscape associated with TLCD1 across a spectrum of cancers, while shedding light on the potential links between TLCD1 expression within the tumor microenvironment and immune infiltration characteristics. Methods: TLCD1 expression data were obtained from GTEx, TCGA, and HPA data repositories. Multiple databases including TIMER, HPA, TISIDB, cBioPortal, GEPIA2, STRING, KEGG, GO, and CancerSEA were used to investigate the expression pattern, diagnostic and prognostic significance, mutation status, functional analysis, and functional status of TLCD1. In addition, we evaluated the relationship between TLCD1 expression and immune infiltration, tumor mutational burden (TMB), microsatellite instability (MSI), and immune-related genes in pan-cancer. Furthermore, the association of TLCD1 with drug sensitivity was analyzed using the CellMiner database. Results: We found that TLCD1 is generally highly expressed in pan-cancers and is significantly associated with the staging and prognosis of various cancers. Furthermore, our results also showed that TLCD1 was significantly associated with immune cell infiltration and immune regulatory factor expression. Using CellMiner database analysis, we then found a strong correlation between TLCD1 expression and sensitivity to anticancer drugs, indicating its potential as a therapeutic target. The most exciting finding is that high TLCD1 expression is associated with worse survival and prognosis in GBM and SKCM patients receiving anti-PD1 therapy. These findings highlight the potential of TLCD1 as a predictive biomarker for response to immunotherapy. Conclusion: TLCD1 plays a role in the regulation of immune infiltration and affects the prognosis of patients with various cancers. It serves as both a prognostic and immunologic biomarker in human cancer.

Prognosis of glioblastoma patients improves significantly over time interrogating historical controls

BackgroundGlioblastoma (GBM) is the most common devastating primary brain cancer in adults. In our clinical practice, median overall survival (mOS) of GBM patients seems increasing over time. MethodsTo address this observation, we have retrospectively analyzed the prognosis of 722 newly diagnosed GBM patients, aged below 70, in good clinical conditions (i.e. Karnofsky Performance Status –KPS- above 70%) and treated in our department according to the standard of care (SOC) between 2005 and 2018. Patients were divided into two groups according to the year of diagnosis (group 1: from 2005 to 2012; group 2: from 2013 to 2018). ResultsCharacteristics of patients and tumors of both groups were very similar regarding confounding factors (age, KPS, MGMT promoter methylation status and treatments). Follow-up time was fixed at 24 months to ensure comparable survival times between both groups. Group 1 patients had a mOS of 19 months ([17.3–21.3]) while mOS of group 2 patients was not reached. The recent period of diagnosis was significantly associated with a longer mOS in univariate analysis (HR=0.64, 95% CI [0.51 – 0.81]), p < 0.001). Multivariate Cox analysis showed that the period of diagnosis remained significantly prognostic after adjustment on confounding factors (adjusted Hazard Ratio (aHR) 0.49, 95% CI [0.36–0.67], p < 0.001). ConclusionThis increase of mOS over time in newly diagnosed GBM patients could be explained by better management of potentially associated non-neurological diseases, optimization of validated SOC, better management of treatments side effects, supportive care and participation in clinical trials.

Regorafenib and glioblastoma: a literature review of preclinical studies, molecular mechanisms and clinical effectiveness.

Glioblastoma IDH wild type (GBM) is a very aggressive brain tumour, characterised by an infiltrative growth pattern and by a prominent neoangiogenesis. Its prognosis is unfortunately dismal, and the median overall survival of GBM patients is short (15 months). Clinical management is based on bulk tumour removal and standard chemoradiation with the alkylating drug temozolomide, but the tumour invariably recurs leading to patient's death. Clinical options for GBM patients remained unaltered for almost two decades until the encouraging results obtained by the phase II REGOMA trial allowed the introduction of the multikinase inhibitor regorafenib as a preferred regimen in relapsed GBM treatment by the National Comprehensive Cancer Network (NCCN) 2020 Guideline. Regorafenib, a sorafenib derivative, targets kinases associated with angiogenesis (VEGFR 1-3), as well as oncogenesis (c-KIT, RET, FGFR) and stromal kinases (FGFR, PDGFR-b). It was already approved for metastatic colorectal cancers and hepatocellular carcinomas. The aim of the present review is to focus on both the molecular and clinical knowledge collected in these first three years of regorafenib use in GBM.

Predictive value of CCL2 in the prognosis and immunotherapy response of glioblastoma multiforme

BackgroundGlioblastoma multiforme (GBM) is the most common and lethal primary brain tumor with a poor prognosis. The C-C motif chemokine ligand 2 (CCL2) has shown abnormal expression associated with progression of multiple malignancies, however, its role in predicting the prognosis and immunotherapy response of GBM remains poorly understood.ResultsCCL2 was highly expressed in GBM as analyzed by integrating CGGA, GEPIA and UALCAN online platforms, and further verified by histologic examinations, qRT-PCR analysis, and independent GEO datasets. CCL2 could serve as an independent prognostic factor for both the poor overall survival and progression-free survival of GBM patients based on TCGA data, univariate and multivariate cox analyses. Functional enrichment analysis revealed that CCL2 mainly participated in the regulation of chemokine signaling pathway and inflammatory response. Further, CCL2 expression was positively correlated with CD4 T cells, macrophages, neutrophils and myeloid dendritic cells infiltrating GBM as calculated by the TIMER2.0 algorithm. Importantly, the tumor immune dysfunction and exclusion (TIDE) algorithm showed that in CCL2-high GBM group, the expression of CD274, CTLA4, HAVCR2 and other immune checkpoints were significantly increased, and the immune checkpoint blockade (ICB) therapy was accordingly more responsive.ConclusionsCCL2 can be used as a predictor of prognosis as well as immunotherapy response in GBM, offering potential clinical implications.

NCOG-33. GLIOBLASTOMA AND PARKINSONISM, IS DEPLETED DOPAMINE A PROTECTIVE SURVIVAL FACTOR? A CASE SERIES OF 3 GBM PATIENTS

Abstract Glioblastoma multiforme (GBM) is the most common malignant brain tumor, and carries a grave prognosis with a median survival of 15 months. The pathophysiologic hallmark of Parkinson’s disease is neuronal loss of dopamine producing cells in the substantia nigra. Dopamine has been shown to modify cell-cycle status in neural progenitor cells. Dopamine agonism is adequate to increase progenitor proliferation in the subventricular zone (SVZ). Dopamine receptor antagonists have antiproliferative effects. A few clinical trials use selective dopamine receptor D2 (DRD2) inhibitors. Parkinsonism can have organic etiologies like stroke or neoplasm, while idiopathic Parkinsonism is known as Parkinson’s disease. While uncommon to have dual diagnoses, we identified three patients with both GBM and Parkinsonism, all were IDH wildtype, 2 patients were MGMT methylated, mean age was 67 years. Our 3 patients have a combined median PFS of 23.4 months, mean PFS of 25.4 months, which compares favorably to historical control median PFS of 6.9 months. Our 3 patients with dual diagnosis have a median OS of 47.3 months, and mean OS of 43.7 months, which compares favorably to historical median OS of 14.6 months. One might expect a patient with a neurodegenerative disease like Parkinson’s disease and a highly malignant tumor like GBM to have an extremely poor prognosis, yet our patient cohort reveals the opposite. The improved overall survival in GBM patients with Parkinsonism supports further clinical research into selective dopamine receptor inhibitors.

CTIM-29. FINAL EFFICACY AND CORRELATIVE ANALYSES OF 2-THE-TOP: A PILOT STUDY OF TTFIELDS (OPTUNE) PLUS PEMBROLIZUMAB PLUS MAINTENANCE TEMOZOLOMIDE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (NDGBM)

Abstract INTRODUCTION TTFields induce anti-tumor immunity via the STING and AIM2 inflammasomes. Thus, TTFields-treated GBM cells may provide a complete in situ vaccination platform and synergize with immune checkpoint inhibitors to prolong survival in GBM patients. METHODS We enrolled 26 ndGBM patients in a pilot study combining TTFields, pembrolizumab and maintenance temozolomide (TMZ). To distinguish immune effects of TTFields from pembrolizumab, TTFields starts at cycle 1 of TMZ while pembrolizumab (200mg Q3Wks) at cycle 2. The primary endpoint is PFS versus a case-matched cohort of 56 patients from the EF-14 study. Secondary endpoints include OS, toxicity, and mechanism of response by multiomics of PBMCs and tumors. RESULTS The median age was 60.5 years. Fourteen (54%) had biopsy only or partial resection. Nineteen (73%) had unmethylated MGMT and 3 (11.5%) had an IDH mutation. Median PFS was 12.0 months versus 5.8 months in controls (HR = 0.377; 95CI: 0.217-0.653; P = 0.0026). Median OS was 24.8 months versus 14.6 months in controls (HR = 0.522; 95CI: 0.301-0.905; P = 0.047). Importantly, residual tumor size positively correlated with the objective response and survival. Six of 15 (40%) patients with measurable disease achieved partial to complete response. The most common SAEs were thromboses, seizures, and metabolic disturbances in 4 (15%), 3 (11.5%), and 2 (7.7%) patients, respectively. Molecular analyses confirmed robust T cell activation by TTFields via T1IFN-dependent plasmacytoid dendritic cells (Spearman coefficient = -0.8; P = 0.014). Successful clonal replacement of the most expanded T cell clones after pembrolizumab strongly predicted objective responses to the triple combination in a Cox HR fit model (concordance rate = 0.876; P = 0.031). CONCLUSIONS The triple combination was well tolerated and demonstrated promising efficacy in ndGBM. Bulky residual disease was associated with better outcomes, consistent with the in-situ immunizing properties of TTFields, which synergize with pembrolizumab. Additional molecular analysis will be updated

TMIC-17. THE ROLE OF ICAM1 IN GLIOBLASTOMA TUMORIGENESIS UNDER HYPOXIC CONDITIONS

Abstract Glioblastoma (GBM) is a deadly brain cancer in adults with limited treatment options. Cell adhesion molecules (CAMs) mediate cell-cell interactions and migration. Intercellular adhesion molecule 1 (ICAM-1) is a CAM expressed by various cell types in solid tumors, including macrophages, tumor and endothelial cells. We previously demonstrated that ICAM-1 expression is linked to shorter overall survival in GBM patients. We observed elevated ICAM-1 levels in hypoxic regions of GBMs. Considering the role of tumor-associated macrophages (TAMs) in GBM tumorigenicity, our objective was to investigate how ICAM-1 expression in TAMs contributes to GBM growth within the hypoxic tumor microenvironment (TME). We employed a comprehensive approach utilizing in vitro and in vivo models, as well as genomic analyses at both bulk and single-cell levels, to elucidate the association between ICAM-1 and TAMs in tumorigenicity. Our findings demonstrated that injecting GBM cells into ICAM-1 knockout mice led to prolonged survival, smaller tumors, reduced macrophage infiltration, and enhanced M1-like polarization of TAMs. Additionally, bone marrow reconstitution experiments confirmed the tumor-promoting role of ICAM-1-expressing TAMs. Cell deconvolution, immunohistochemical, and flow cytometry analyses of mouse tumors supported these findings. Gene set enrichment analysis of differentially expressed genes in xenografted tumors revealed that ICAM-1 presence upregulated key tumorigenic pathways, including epithelial-mesenchymal transition, IL2-STAT5, TNF-α via NFκB, IL6-JAK-STAT3, and RAS/MAPK. In vitro analysis indicated that ICAM-1 promoted macrophage migration and polarization towards M2-like state, which was further augmented by hypoxia-induced ICAM1 expression. Flow cytometry, cytometry by time of flight (cyToF), and single-cell RNA sequencing analysis of human and mouse GBMs revealed elevated ICAM-1 expression in hypoxic TAMs, suggesting the hypoxic microenvironment promotes the tumorigenic functions of TAMs. In conclusion, ICAM1 likely enhances GBM tumorigenesis by promoting TAM migration into the TME. Furthermore, environmental factors such as hypoxia contribute to increased ICAM-1 expression in TAMs, further exacerbating GBM tumorigenicity.

BIOM-66. ESTABLISHMENT OF A PROGNOSTIC MODEL FOR GLIOBLASTOMA MULTIFORME MAGNETIC RESONANCE IMAGING BASED ON IMBALANCED CLASSES, CLASSIFICATION, AND KAPLAN-MEIER SURVIVAL CURVE LEARNING ALGORITHMS

Abstract Glioblastoma multiforme (GBM) is a rapidly invasive brain tumor with a high mortality rate. It is accompa-nied by peripheral edema. Physicians use magnetic resonance imaging (MRI) to diagnose each patient’s con-dition in clinical practice. The current use of machine learning to classify brain tumors has an accuracy of about 90% in most studies. Therefore, this study aimed to improve its prediction accuracy using machine learning models to predict GBM patient survival or non-survival. The study used MRI T1-related and T2-related sequences to obtain GBM tumor and edema area attributes. It then divided them into four da-tasets: maximum tumor area, maximum edema area, total tumor volume, and total edema volume. These four datasets were used as inputs for classification models based on support vector machines, decision tree algo-rithms, random forest algorithms, and multilayer perceptron (MLP) to predict patient survival. A confusion matrix was used to evaluate each model and determine the most suitable models for each dataset based on their accuracy. MLP was the most appropriate for predicting the overall edema volume dataset, with the highest accuracy in predicting GBM patient survival or non-survival at 96.97%. Hopefully, this study can assist physicians in assessing and diagnosing GBM patients’ survival status in the future. Keywords: Classification Models; Glioblastoma Multiforme; KaplanMeier Curve; Magnetic Resonance Imaging; Peritumoral Edema

DDDR-33. TNG908, A BRAIN-PENETRANT MTA-COOPERATIVE PRMT5 INHIBITOR, IS EFFICACIOUS IN PRECLINICAL MTAP-DELETED MODELS INCLUDING GLIOBLASTOMA

Abstract Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. The median overall survival (OS) of GBM patients is poor (1-2 years) with standard of care therapies, demonstrating the significant need for the development of novel therapeutics. TNG908 is a clinical stage MTA-cooperative PRMT5 inhibitor that is selectively active in MTAP-deleted cells by leveraging a synthetic lethal interaction. Approximately 40% of GBM tumors have MTAP loss due to a co-deletion event with the proximal tumor suppressor gene, CDKN2A. In preclinical in vitro studies, TNG908 was 15-fold more potent in MTAP-deleted cancer cell lines than in MTAP WT cells. TNG908 has high passive permeability and is neither a substrate for P-glycoprotein nor Breast Cancer Resistant Protein (BCRP) efflux transporters. Consistent with these favorable attributes, TNG908 demonstrated in vivo brain penetration in multiple preclinical models, including non-human primates and mice. TNG908 on-target pharmacodynamic activity was determined by dose-dependent decreases in SDMA-modified protein levels in a GBM subcutaneous xenograft model. TNG908 demonstrated dose-dependent antitumor activity in multiple hyper- and hypomethylated GBM subcutaneous models, including cell lines and patient-derived xenograft models. Despite 6-fold reduced Kpuu in rodents (Kpuu ~0.15) relative to non-human primates (Kpuu 0.9), oral administration of TNG908 drove near tumor stasis and increased median survival by 3-fold in a highly aggressive murine GBM orthotopic model. In summary, TNG908 is a potent, brain-penetrant, MTA-cooperative PRMT5 inhibitor that drives strong antitumor activity in preclinical models of MTAP-deleted GBM. TNG908 is currently enrolling patients with MTAP-deleted tumors including glioblastoma in a Phase I/II clinical trial (NCT05275478).

CTNI-16. USE OF PREDICTIVE SCORE-BASED HISTORICAL CONTROL DATA IN SINGLE-ARM TRIALS

Abstract Even though the randomized controlled trials (RCTs) are still the preferred approach to evaluate the effects of treatments, single-arm study designs have been traditionally used in Phase II oncology clinical trials. The single-arm studies using historical control or external control might be inevitable and even fatal when concurrent controls are impractical or unethical in rare and high-risk diseases. Due to recruiting difficulty, ethical and economic reasons, the single-arm trials can be a good option to test the experimental efficacy with the external control data of historical control rates for early efficacy phase 2 trials in glioblastoma. The FDA guidelines on external control data focus on the use of patient-level data from other clinical trials or real-world data (RWD), and so there is no guidance for summary-level historical control. Furthermore, there exist methodological issues to use historical data like identification of relevant data, amount of discounting (time difference and dissimilarity), prior robustness or operating characteristics. In this study, we propose a synthetic data based predictive scoring method optimally to match the historical control data with the characteristic conditions of the experimental studies. We consider both a binary (PFS on six months) and survival (median PFS) endpoints as surrogates for Phase 2 single-arm trials in newly diagnosed and recurrent glioblastoma patients. We perform meta-analysis to summarize the endpoints and the related socio-demographic, treatment and genetic factors from the summary-level historical data. Then we generate the synthetic patients based on the meta-summarized data. The generalized boosted regression models will be used to identify significant characteristics affecting the survival of GBM patients using the synthetic data. Finally the predictive score-based historical data model will be developed to provide the optimal matching with the characteristics of the experimental studies. This study will be validated using existing patient-level data as well as cross-validation methods.

STEM-14. TARGETING HAUSP IN GLIOMA STEM CELLS INHIBITS MALIGNANT GROWTH AND OVERCOMES RADIORESISTANCE OF GLIOBLASTOMA

Abstract Glioblastoma (GBM) is the most lethal and common type of primary brain tumor highly resistant to current treatments including radiotherapy. GBM contains heterogeneous cancer cells including glioma stem cells (GSCs) that promote malignant growth and therapeutic resistance, indicating that targeting GSCs may effectively improve GBM therapy. Here, we show that HAUSP (USP7, a deubiquitinase) is preferentially expressed by GSCs in the perivascular niches in human GBMs. Disrupting HAUSP by shRNA or its inhibitor P22077 promoted GSC differentiation, impaired GSC growth, and potently inhibited GBM malignant growth, indicating that HAUSP is required for maintaining the self-renewal and tumorigenic potential of GSCs. Moreover, pharmacological inhibition of HAUSP synergized with irradiation (IR) to suppress GBM tumor growth, suggesting that targeting HAUSP may effectively overcome GSC-driven radioresistance to improve therapeutic efficacy for GBM. Our findings uncover a novel role of HAUSP in maintaining GSC phenotypes and tumorigenic potential, and thus offer a promising druggable target for developing anti-GSC therapeutics to improve GBM treatment. Furthermore, our preclinical data suggest that inhibiting HAUSP alone or in combination with IR may prolong the survival of GBM patients.

Genetic Engineering of Hematopoietic Progenitor Stem Cells for Targeted IFN-α Immunotherapy Reprogramming the Solid Tumor Microenvironment: A First-in-Man Study in Glioblastoma Multiforme (NCT03866109)

Background and methods . TEM-GBM is a Phase 1/2a dose-escalating non-randomized open label study, involving a single intravenous injection of Temferon. Temferon is constituted by autologous CD34+ HSPCs genetically modified with a lentiviral vector encoding for human interferon-a2 and has been designed to deliver IFNa in the tumor microenvironment (TME) in a targeted manner via Tie-2 expressing monocytes (TEMs). The patient population is newly diagnosed GBM patients with unmethylated MGMT gene promoter. The study aims to evaluate the short-term (up to 90 Days) and long-term (up to 2 years) tolerability and safety of five escalating doses of Temferon in up to 27 glioblastoma patients. The secondary objective is to evaluate biological activity and efficacy when used following SOC first line therapeutic approaches. Autologous CD34+ HSPC are mobilized with lenograstim and plerixafor, collected by apheresis, purified and ex vivo modified with a lentiviral vector. So far, up to 3 million Temferon cells/kg have been co-administered with a fixed dose of non-manipulated CD34+ supporter cells following a sub-myeloablative conditioning regimen (Thiotepa + BCNU or Busulfan or Busulfan alone). Results. As of 30th June 2023, twenty-one patients have been enrolled across 7 cohorts evaluating 4 incremental doses (0.5-3.0x10 6/kg) of Temferon. To date, no DLTs have been identified. Median Overall Survival after 1st surgery is 17 months (5-40 months). In all patients, rapid engraftment of gene modified progenitors and fast recovery from sub-myeloablative conditioning regimens have been observed (median engraftment across all the cohorts: Neutrophils D+12, Platelets D+13,5 following Temferon infusion). The percentage of transduced cells found in the BM obtained for the highest dose reached 50% at 1 month and persisted at detectable level in the long-term. Very low median concentrations of IFNa were detected in the plasma, indicating tight regulation of vector expression. Notably, the concentration of IFNa in the CSF increased concomitantly with disease progression suggesting active recruitment of TEMs into the tumor and subsequent release of IFNa. 57% of the treated patients underwent a 2nd-line treatment (either pharmacological or surgical) with an interim survival rate at 2-years of 28% (5 of 18 patients; 3 patients excluded as follow-up is below 12 months), which is higher than what is reported in literature (15%). One out of the surviving patients was enrolled in a long-term follow-up study and survived up to 3 years after surgery without any 2nd-line therapy. Genetically engineered cells were detected within the tumor lesion at levels &amp;gt;3% in 3/6 patients at second surgery. Single cell RNA seq analysis unveiled reprogramming of the myeloid TME, with an increase in pro-inflammatory (M1-like) and a decrease in hypoxic (M2-like) macrophages following Temferon exposure. Of note, this population shift was particularly evident when comparing a stable with a progressive tumor lesion biopsied contemporaneously in one patient, reproducing preclinical findings from a GBM mouse model (PMID: 35857642). Analysis of the T cell compartment highlighted an overall increase of CD8+ T cells (mainly effector T cell subsets) and a decrease in CD4+ T cells in Temferon patients. By mapping published signatures of antitumor neoantigen-reactive T cells (NeoTCR; PMID: 35113651) onto the GBM T cell landscape and integrating this data with clonal frequency metrics from concurrent scTCRseq data, we observed an approximately 3-fold increase of predicted tumor-reactive CD8+ T cells bearing expanded clonotypes (&amp;gt;1% within each patient) in Temferon vs. control patients. Strong up-regulation of IFNa and inflammatory responses in most of the clusters from myeloid and T cells, but also CD45- tumor and stromal cell compartments from Temferon patients suggested diffuse IFNa payload delivery into the GBM TME. Conclusion: These data show that Temferon is safe and biologically active at the tumor site and favors anti-tumor immunity. The results provide initial evidence of Temferon's potential to modulate the TME of GBM patients and to counteract disease progression and improve the survival of uMGMT GBM patients.

Predicting survival in glioblastoma with multimodal neuroimaging and machine learning

PurposeGlioblastoma (GBM) is the most common and aggressive malignant glioma, with an overall median survival of less than two years. The ability to predict survival before treatment in GBM patients would lead to improved disease management, clinical trial enrollment, and patient care.MethodsGBM patients (N = 133, mean age 60.8 years, median survival 14.1 months, 57.9% male) were retrospectively recruited from the neurosurgery brain tumor service at Washington University Medical Center. All patients completed structural neuroimaging and resting state functional MRI (RS-fMRI) before surgery. Demographics, measures of cortical thickness (CT), and resting state functional network connectivity (FC) were used to train a deep neural network to classify patients based on survival (< 1y, 1-2y, >2y). Permutation feature importance identified the strongest predictors of survival based on the trained models.ResultsThe models achieved a combined cross-validation and hold out accuracy of 90.6% in classifying survival (< 1y, 1-2y, >2y). The strongest demographic predictors were age at diagnosis and sex. The strongest CT predictors of survival included the superior temporal sulcus, parahippocampal gyrus, pericalcarine, pars triangularis, and middle temporal regions. The strongest FC features primarily involved dorsal and inferior somatomotor, visual, and cingulo-opercular networks.ConclusionWe demonstrate that machine learning can accurately classify survival in GBM patients based on multimodal neuroimaging before any surgical or medical intervention. These results were achieved without information regarding presentation symptoms, treatments, postsurgical outcomes, or tumor genomic information. Our results suggest GBMs have a global effect on the brain’s structural and functional organization, which is predictive of survival.