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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Monograph - Perspectives In Central Nervous System Malignancies


Goal
To provide neuro-oncologists and radiation oncologists with up-to-date information on central nervous system malignancies.

Target Audience
This activity is designed for neuro-oncologists and radiation oncologists. No prerequisites required.

Learning Objectives
At the conclusion of this activity, the participant should be able to:

  • Discuss the latest trends in diagnosing central nervous system (CNS) malignancies.
  • Identify how various factors affect the prognosis of CNS malignancies.
  • Evaluate novel treatment strategies and emerging agents for the management of gliomas.
  • Differentiate among and apply the least invasive techniques for re-irradiation of gliomas.
  • Describe the heterogeneity within tumor types and the key factors to consider when developing treatment plans tailored to individual patients.
  • Incorporate information and conclusions from recent clinical trials into daily clinical practice, especially the management of gliomas.

Accreditation Statement
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Estimated time to complete activity: 1 hour

After reading this monograph, participants may receive credit by completing the CME test, evaluation, and receiving a score of 70% or higher.

Release date: July 15, 2008. Expiration date: July 15, 2010.

Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Schering-Plough.

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Directors and Participating Faculty reported the following:

COURSE DIRECTORS

Stuart A. Grossman, MD
Professor, Oncology, Medicine, and Neurosurgery
The Johns Hopkins University
Baltimore, Maryland
Dr Grossman reports having no significant financial or advisory relationships with
corporate organizations related to this activity.

Martin J. van den Bent, MD, PhD
Professor, Department of Neuro-Oncology
Daniel den Hoed Cancer Center
Erasmus University Medical Center
Rotterdam, The Netherlands
Dr van den Bent reports receiving grants/research support from Novartis
Pharmaceuticals Corporation; serving as a consultant for Adnexus, Novartis
Pharmaceuticals Corporation, and Schering-Plough Corporation; and serving on the
speakers’ bureau for Schering-Plough Corporation.

W. K. Alfred Yung, MD
Chairman, Department of Neuro-Oncology
Margaret and Ben Love Chair of Clinical Cancer Care
MD Anderson Cancer Center
Houston, Texas
Dr Yung reports receiving grants/research support from Genentech, Inc, Novartis
Pharmaceuticals Corporation, and Schering-Plough Corporation; serving as a consultant
for and receiving honoraria from Myriad, Novartis Pharmaceuticals Corporation, and Schering-Plough Corporation; and serving on the speakers’ bureau for Schering-Plough Corporation.

PARTICIPATING FACULTY

Brigitta G. Baumert, MD, PhD
Radiation Oncologist
Department of Radiation-Oncology (MAASTRO)
Grow (Research Institute Growth and Development)
Maastricht University Medical Center
Maastricht, The Netherlands
Dr Baumert reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Matthias Preusser, MD
Neurooncologist
Medical University of Vienna
Vienna, Austria
Dr Preusser reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Walter Taal, MD
Neurooncologist
Department of Neuro-Oncology
Daniel den Hoed Cancer Center
Erasmus University Medical Center
Rotterdam, The Netherlands
Dr Taal reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Stefaan Van Gool, MD, PhD
Kliniekhoofd, Buitengewoon Hoogleraar
Pediatric Hemato-oncology and Neuro-oncology
University Hospital Gasthuisberg
Laboratory of Experimental Immunology
Leuven, Belgium
Dr Van Gool reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Notice: No faculty member has indicated that his or her article will include information on off-label products.

Johns Hopkins Advanced Studies in Oncology provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins Advanced Studies in Oncology does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Perspectives In Central Nervous System Malignancies
Stuart A. Grossman, MD,* Martin J. van den Bent, MD, PhD,† and W. K. Alfred Yung, MD‡  
   

    The detection and management of gliomas remains one of the most challenging areas in medicine. Despite the introduction of several newer diagnostic techniques and various multimodal forms of therapy, the prognosis for these deadly tumors has remained largely unchanged over the past 3 decades.
     Today we are on the verge of many exciting scientific and clinical breakthroughs in the care of patients with gliomas. Results of preclinical and ongoing clinical trials have demonstrated the value of new techniques for diagnosis and follow-up assessment, along with new treatment methods. Newer imaging techniques can help the clinician distinguish true progression from pseudo-progression, thereby avoiding unnecessary surgery and chemotherapy.
     The introduction of temozolomide as adjuvant therapy to the standard regimen of surgery and radiation in patients with glioblastoma has yielded a significant and clinically relevant survival advantage that provides a standard of comparison for future research. Studies are under way to determine the role of temozolomide treatment in anaplastic and low-grade gliomas. Potential targets for other drug treatments are the receptors for endothelial growth factor and tyrosine kinase and phosphoinositide (PI) 3 kinase inhibitors. Preliminary studies with these drugs have shown varying response rates, but further research is indicated.
     Classifying the heterogeneity within tumor types should lead to the identification of gene markers to determine how tumors will respond to particular treatments, aiding in the development of individualized patient treatment plans. The study of tumor vasculature will help to identify the various antitumor effects of anti-angiogenesis agents, improving the efficacy of these agents. Preliminary research has assessed the influence of CD4 counts on survival in patients with high-grade gliomas.
Advances in the understanding of immunology are being used to elucidate the role of immunologic factors in the development and progression of gliomas. Trials of immunotherapy have shown promising survival times when patients are vaccinated with mature dendritic cells derived from the resected tumor. The establishment of large multicenter clinical trials of immunotherapy will provide valid and reliable information that is expected to lead to better patient care and increased survival.
   This issue of Johns Hopkins Advanced Studies in Oncology includes summaries of presentations from the PCNSM4: Perspectives in Central Nervous System Malignancies conference held on March 28-29, 2008, in Berlin, Germany. The annual PCNSM conference is developed and managed by Imedex®. Matthias Preusser, MD, from the Medical University of Vienna, discussed optimal approaches to assessing methylguanine methyltransferase expression. Martin J. van den Bent, MD, PhD, and Walter Taal, MD, both from the Daniel den Hoed Cancer Center at Erasmus University Medical Center, reviewed new data on tumor "pseudo-progression", offering suggestions about how to improve the diagnosis of true progression. W. K. Alfred Yung, MD, from the MD Anderson Cancer Center, reviewed the molecular aspects of glioblastoma, explaining the rationale for the development of PI3 kinase inhibitors. Stefaan Van Gool, MD, PhD, from University Hospital Gasthuisberg, provided encouraging survival data achieved by processing tumor cells and using the product as a vaccine against gliomas. And finally, Brigitta G. Baumert, MD, PhD, from Maastricht University Medical Center, reviewed the value of re-irradiation after early failure of local treatment in high-grade gliomas, noting which techniques are most appropriate. These summaries were identified by the conference chairs, Dr van den Bent and Dr Yung, to provide neuro-oncologists and radiation oncologists with some of the most up-to-date information regarding the diagnosis, management, and treatment of patients with central nervous system malignancies.


*Professor, Oncology, Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

†Professor, Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus University Medical Center, Rotterdam, The Netherlands.

‡Chairman, Department of Neuro-Oncology, Margaret and Ben Love Chair of Clinical Cancer Care, MD Anderson Cancer Center, Houston, Texas.

Address correspondence to: Stuart A. Grossman, MD, Professor, Oncology, Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, MD 21231. E-mail: grossman@jhmi.edu.

The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his or her article and all its contents.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.