多伦多病童医院脑干胶质瘤ppt课件.ppt

Are they true DIPG? October 2011 January 2012 January 2017 Long term survivor Diffuse brainstem GliomasNorth American studies Few studies open Future studies Brainstem Gliomas Recently closed ACNS 0927: phase II study of SAHA (vorinostat) during and after radiation Open ADVL 1217 (A phase I study of MK-1775 concurrent with local radiation therapy for the treatment of newly diagnosed children with diffuse intrinsic pontine gliomas (DIPG)) Soon? Arsenic trioxyde (antivascular effect, radiosensitizer) Brainstem Gliomas PBTC studies: PARP inhibitor + Temozolomide + radiation (closed for futility) Pembrolizumab (closed for toxicity) Panabinostat (HDAC inhibitor) currently recruiting Biospy for DIPG: Why? How? Frame-based Frame less No indication for DIPG How is it done? Limitations No direct benefit for the patient yet Clear explanation Parents informed consent Risk of neurological deterioration Small few samples Necker series 65 stereotactic biopsies of DIPG 4 patients refused Number of samples increased with time (up to 8) Histological diag Frozen samples Stem cell cultures No mortality No permanent morbidity 3 transient morbidity (facial nerve palsy associated with increased motor deficit in 1 case) 2 tumoral dissemination along the trajectory Biopsy Cohort 1 MGMT- EGFR- Cohort 2 MGMT- EGFR+ Cohort 3 MGMT+ EGFR- Cohort 4 MGMT+ EGFR+ RT Bevacizumab RT Bevacizumab Erlotinib RT Bevacizumab Temozolomide RT Bevacizumab Erlotinib Temozolomide 4 Weeks Bevacizumab 4 Weeks Bevacizumab Erlotinib 4 Weeks Bevacizumab 4 Weeks Bevacizumab Erlotinib Maintenance Bevacizumab Maintenance Bevacizumab Erlotinib Maintenance Bevacizumab Temozolomide Maintenance Bevacizumab Erlotinib Temozolomide MRI Diagnosis DIPG TREATMENT SCHEMA Enrollment Tissue Analyses Boston/UCSF protocol Convection delivery (Lonser J Child Neurol 2008) Brainstem glioma Patient 3-year, 10-month-old female History Diagnosed (May 2005) Headaches and falling Radiation th