Neuro-Oncology Branch Receives Awards at the 2021 Society for Neuro-Oncology Annual Meeting
, by Kristin Odom, NCI-CONNECT Communications Editor
Dr. Heather Leeper and Dr. Marta Penas-Prado
Physicians share findings from two NCI-CONNECT studies in award-winning abstracts.
The 26th Annual Meeting of the Society for Neuro-Oncology (SNO) took place November 18-21, 2021. This meeting provided neuro-oncology scientists and clinicians the opportunity to come together, whether in person or virtually, to discuss the latest advancements in neuro-oncology. The NCI Center for Cancer Research's Neuro-Oncology Branch (NOB) was well represented at the meeting, with 32 accepted abstract presentations during the four-day event.
The synopses of two award-winning presentations by NOB Assistant Research Physician Heather Leeper, M.D., and NOB Associate Research Physician Marta Penas-Prado, M.D., are provided below.
Oral Presentation: Financial Toxicity and Distress During the COVID-19 Pandemic in People Living with Primary Brain Tumors
Received Abstract Award for Excellence in Survivorship
Presenter: Dr. Heather Leeper
Elizabeth Vera, Alvina Acquaye, Nicole Briceno, Anna Choi, Alexa Christ, Ewa Grajkowska, Varna Jammula, Jason Levine, Matthew Lindsley, Jennifer Reyes, Kayla Roche, James Rogers, Michael Timmer, Lisa Boris, Eric Burton, Nicole Lollo, Marissa Panzer, Marta Penas-Prado, Valentina Pillai, Lily Polskin, Brett Theeler, Jing Wu, Mark Gilbert, and Terri Armstrong
People with primary brain tumors experience high symptom burden and functional limitations. This study considered whether economic strain and mood disturbance during the COVID-19 pandemic may have additional impacts on patients’ symptoms and function.
Financial toxicity and associated patient reported outcomes were assessed after one year of pandemic-related lockdown in a cohort of people with primary brain tumors. Financial toxicity includes patients and their family’s out-of-pocket cost, as well as the psychological distress financial hardship causes.
Patient and disease characteristics—as well as patient-reported outcomes, including financial distress (FACIT-COST), symptom burden, anxiety, depression, and health-related quality of life—were collected from July 2020 to May 2021 from participants in the NOB's Natural History Study.
The FACIT-COST questionnaire was designed to describe financial distress experienced by adults living with cancer. Participants were asked 12 questions and the total score ranged from 0 to 44 with lower scores indicating higher financial toxicity. The cohort included 112 patients. The majority were male and white, with an average age of 47 years old. Most were married, completed a four-year college degree, earned an annual family income of ≥ $50,000, and are living with a recurrent high-grade glioma. Fifty-six percent reported some financial hardship due to their illness, and half of the patients reported feeling moderately to extremely anxious or depressed. Non-whites and Hispanics, as well as those not currently working, reported worse financial toxicity compared to white non-Hispanics and individuals currently working.
Worse financial toxicity scores were strongly associated with worse overall symptom burden, worse anxiety and depression scores, and worse overall health-related quality of life scores. The data from this study provide evidence of financial toxicity during the pandemic strongly correlated with symptoms, psychological distress, and health-related quality of life. The study also found differences in financial toxicity across demographic groups, suggesting social factors have greater impact on the financial effects of the survivorship experience than clinical factors.
Oral Presentation: Immune Checkpoint Inhibitor Nivolumab in People with Recurrent Select Rare CNS Cancers: Results of Interim Analysis in a Heavily Pretreated Cohort
Received Abstract Award for Excellence in CNS Rare Disease
Presenter: Marta Penas-Prado
Ying Yuan, Kathleen Wall, Elizabeth Vera, Ukeme Ikiddeh-Barnes, Katie Blackburn, Claudia Chambers, Nivi Ratnam, Stephen Frederico, Alvina Acquaye, Kenneth Aldape, Nicole Briceno, Anna Choi, Alexa Christ, Varna Jammula, Heather Leeper, Jason Levine, Matthew Lindsley, Jennifer Reyes, Kayla Roche, James Rogers, Michael Timmer, Lisa Boris, Eric Burton, Nicole Lollo, Marissa Panzer, Lily Polskin, Valentina Pillai, Martha Quezado, Brett Theeler, Jing Wu, Terri Armstrong, and Mark Gilbert
Data supporting the use of the immunotherapy drug nivolumab in rare central nervous system (CNS) tumors is limited. The immune checkpoint inhibitor phase 2 clinical trial launched in 2017 at the NOB, under the Cancer Moonshot-funded program NCI-CONNECT. It is designed to test whether stimulating the immune system using nivolumab is effective and can shrink (or control the growth or spread of) specific types of recurrent rare brain and spine tumors. The trial is also testing the changes that nivolumab induces in immune cells in peripheral blood during treatment—and whether nivolumab can improve the symptoms of people with these tumors.
Efficacy is measured by disease control rate in two cohorts: those who are heavily pretreated with three or more prior therapies, and those who are non-heavily pretreated with less than three prior treatments. Prior therapies include radiation and/or standard or investigational drugs. The study reports efficacy and safety results from a planned interim analysis—data that is collected before the study has been completed—in the heavily pretreated cohort. The objective of an interim analysis in a clinical trial is to check if it is appropriate to continue the study or to terminate it prematurely, based on efficacy and toxicity data obtained so far.
The trial plans to enroll a total of 150 patients, 75 in each cohort. Nivolumab treatment is given every two weeks (four doses) and then every four weeks (14 additional doses).
As of March 10, 2021, an interim analysis determined that the disease control rate exceeded the minimum required to pass the interim analysis in the heavily pretreated cohort and to continue the trial. Among 30 patients, five achieved stable disease for more than six months. The side effects from nivolumab were similar in frequency and type to previous experience in other cancers.
The clinical trial has recently expanded to many centers in the NCI-CONNECT network to reach more people, which will accelerate accrual to this trial cohort to reach a total of 75. The network is also continuing to enroll patients to the non-heavily pretreated cohort, as the minimum enrollment for interim analysis in this cohort has not been reached yet.