Notes on ESMO17: Tumors of the brain and spinal cord

Clinical Brief – September 29th

ESMO, or the European Society of Medical Oncology Congress, is an annual gathering of cancer experts and patient advocates. Here are some studies from this year’s ESMO that may be of use.

Glioblastoma multiforme is an aggressive type of brain cancer. Lowering the dose of bevacizumab (Avastin) for progressive glioblastoma multiforme may not have a detrimental impact on overall survival.

Researchers from Ireland reviewed the records of patients in their prospective national neuro-oncology center database. Nearly 120 patients were treated with bevacizumab between 2010 and 2016. About 70 patients received the standard dose, and about 50 received only half the dose.

Median overall survival following treatment was similar between patient groups regardless of their bevacizumab dose. Patients receiving the full-dose had median overall survival of 5.6 months vs 5.5 months for those receiving half the dose.

Quality of life analyses are ongoing, and I’ll bet that patients who received half the dose had fewer side effects.

Is cutting the bevacizumab bill in half and sparing patients potentially unnecessary toxicity a good enough reason to start a larger prospective trial? I think so :).

Abstract #349P

An early drop in platelet counts after chemo may be predictive of more serious thrombocytopenia during treatment, suggests a study.

Researchers from the Henri Becquerel Cancer Center in France led the study examining records of 85 patients with newly diagnosed glioblastoma multiforme, an aggressive form of brain cancer.

All patients received temozolomide as their chemo. Nearly 1 in 6 experienced at least one episode of thrombocytopenia during maintenance treatment, which was the most common reason to change their treatment regimen.

A 35% drop in platelet counts six weeks after the start of chemo was identified as “the best predictive” marker of drug-induced thrombocytopenia.

In a separate cohort of 62 patients, researchers retrospectively validated this marker and found that it had a positive predictive value of 42% and a negative predictive value of 92%.

In translation, about 2 out of 5 patients experiencing a 35%+ drop in platelet counts after six weeks of chemo may experience thrombocytopenia that triggers changes in treatment regimens. On the other hand, 9 out of 10 patients who didn’t experience such a drop in platelet counts at the same time point may avoid such a case of thrombocytopenia.

A drop in platelet counts is easy to check and doesn’t cost anything to measure, which makes this marker particularly interesting – provided that it’s reliable. Prospective studies are needed to confirm these findings.

Abstract #335PD

Neutrophil to lymphocyte ratio has been suggested as a potential prognostic marker for melanoma. Now, there’s evidence to suggest similar links in brain cancer.

In a new study, patients with a neutrophil to lymphocyte ratio of at least 4 may be more likely to need corticosteroids for primary malignant brain tumors.

Researchers from the Royal Marsden Hospital in London, UK, led the study involving 100 patients with advanced and refractory primary malignant brain tumor.  About three quarters of patients had glioblastoma multiforme. About 6 in 10 patients needed corticosteroids on first assessment.

Patients with neutrophil to lymphocyte ratio of at least 4 were more likely to need corticosteroids vs those with ratios less than 4 (81% vs 38%).

Being in need of corticosteroid treatment was linked to limited survival. Patients on corticosteroids who had neutrophil to lymphocyte ratios of at least 4 had notably shorter survival vs those who weren’t on a corticosteroid (median overall survival: 4 vs 19 months).

Abstract #346P

For more presentations from #ESMO17, take a look at my hand-curated Twitter moment 🤓.


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