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Presentaciones orales
Gliomas de bajo grado: analisis de 45 casos
Robinson Rodríguez 1, Sonia Acuña1, Florencia Leyes1, Sebastián Ximénez1, Cristina Mara1, Ramiro Lima1, Diego Bertini1, Andrea Ríosi1 1 Unidad de Neuro-oncología, Departamento de Oncología, Hospital de Clínicas, Facultad de Medicina (Montevideo, Uruguay).
Introducción: Los gliomas de bajo grado (GBG) represen-
Resultados: Se revisaron 45 historias clínicas. La mediana de
tan un 30 % de los gliomas del adulto, se caracterizan por edad fue 34 años (15-82 años), 58% hombres y 42% mujeres. presentarse a edades tempranas, con un pico de incidencia Las convulsiones (33% de casos) fue el síntoma de presenta- entre 34 y 45 años. Si bien su manejo óptimo es aun con- ción más frecuente, el diagnóstico imagenológico fue con troversial, el tratamiento quirúrgico con exéresis completa tomografía en el 82% de casos, ubicados el 60% en región ha demostrado mayor impacto en la sobrevida. Aunque la frontal. En cuanto a histología, 70 % fueron oligodendro- sobrevida es larga, tienden a la recurrencia con progresión a gliomas, 14% astrocitomas y 6% oligoastrocitomas. El trata- grados histológicos mayores. Son conocidos como factores miento realizado en primera línea fue la cirugía exclusiva. La adversos: edades mayores de 40 años, la histología astroci- cirugía fue completa en 21 %, casi total 28 %, parcial 26 % y taria, el tamaño tumoral y el déficit neurológico previo a la en 15 % biopsia. El 4 % recibió RT exclusiva, el 2 % QT exclu- cirugía, factores que tienen implicancia negativa en la so- siva y observación 2 %. La QT empleada sola o en asociación a otros tratamientos fueron, Carmustina 70 %, Procarbacina 20 % y Carboplatino-Etopósido 10 %. En primera recaída, se Pacientes y Métodos: Se trata de un estudio retrospectivo,
reoperaron el 80 %, evolucionando a grado III el 33 % de los descriptivo y observacional, cuyo objetivo es analizar las ca- pacientes. La sobrevida libre de recaída fue de 112 meses y la racterísticas clínicas, histológicas y de tratamiento recibido en pacientes portadores de gliomas de bajo grado (II de la OMS); y analizar la sobrevida libre de progresión y sobrevida Conclusiones: En nuestra casuística predominaron los oligo-
global, en las pacientes tratados en la Unidad de Neuro-on- dendrogliomas y en cuanto a la sobevida, la misma no difiere cología del Hospital de Clínicas de Montevideo, durante el de los reportes internacionales. Eventualmente un estudio periodo de mayo 1991 a marzo 2011. Los datos se recolecta- de perfil molecular y especialmente múltiples variables, po- ron desde las historias clínicas de los pacientes asistidos en dría demostrar cuales son las características tumorales, así la Unidad durante el periodo descrito.
como de tratamiento que inciden en la sobrevida.
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Presentaciones orales
Criteria for Methodology of Anti – Gene Anti IGF-I Therapy of Glioblastoma
Jerzy Trojan 1-2, Ignacio Briceno2, Donald D. Anthony3 1 INSERM U602, Paul Brousse Hospital, Paris XI University (Villejuif, France)2 Faculty of Medicine, La Sabana University (Chia, Colombia) 3 Deptartment of General Medicine, School of Medecine, CWRU University (OH, US) Introduction: The criteria for methodology of cellular gene
successive vaccinations, have demonstrated an increasing therapy of “anti – gene anti IGF-I” type, for malignant tu- level of CD8+ and CD8+28+ molecules (with a switch from mours: cancers of prostate, uterus, ovary, colon, liver, and particularly for glioblastoma multiforme were to be estab-lished. Conclusions: The immune criteria considered as sine qua
non of efficient anti-gene anti IGF-I therapy have permitted
Methods: The cancer patients, after classical therapy of sur-
to increase the survival of glioblastoma patients up to two gery, radiotherapy and chemotherapy, have undergone the years (using classical surgery and radiotherapy followed by subcutaneous injection of modified genetically autologous chemotherapy, the median survival is generally 14 months, malignant cells - transfected by IGF-I antisense/triple helix Results: The principal therapy concerned glioblastoma pa-
tients; the minimum survival of the treated patients was
19 months and maximum 24 months; in some rare cases
3-4 years. For all cancer patients supervised also up to 19
months, the following common immune criteria for “anti
IGF-I” strategy were admitted: 1) characteristics of cell “vac-
cines” - absence of IGF-I and expression of MHC-I (mediated
by TAP-1 and -2) in cloned transfected cells; 2) the peripheral
blood lymphocytes, PBL cells, removed after every of three
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Presentaciones orales
Antiepileptic drug efficacy in gliobastoma patients (RedLANO 2013)
Andrés Felipe Cardona 1-3, Luis Carlos Mayor4, Enrique Jiménez Hakim5, Fernando Hakim5, Juan Armando Mejía5, Nicolás Useche6, Sonia Bermúdez6, Hernán Carranza1-2, Carlos Vargas1-2, Jorge Otero1-2, Carmen Balaña7, León Darío Ortíz3-8 1 Clinical and Translational Oncology Group, Instituto de Oncología, Fundación Santa Fe de Bogotá, Bogotá, Colombia2 Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer (FICMAC), Bogotá, Colombia3 Red Latino Americana de Neuro-Oncología (RedLANO)4 Neurology Department, Epileptology Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia5 Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia6 Diagnostic Images Department, Neuro-Radiology Section, Fundación Santa Fe de Bogotá7 Departamento de Oncología Médica, Sección Neuro-Oncología, Instituto Catalán de Oncología (ICO), Barcelona, Spain8 Clinical Oncology Department, Neuro-oncology Section, Instituto de Cancerología, Clínica Las Américas, Medellín, Colombia Introduction: Epilepsy is a common symptom in patients
aged over 60-yo (p=0.13) amongst those having worse func- tional state (p=0.24) or according to the localisation of the primary tumour (p=0.34). Epileptic crises and the need for Methods: The study included data regarding 213 patients
some type of medicament for controlling them were greater from the RedLANO follow-up registry. We recorded demo- in those having primary GBs (p=0.004). Mean time for the graphics, date of first seizure, anti-epileptic drugs (AED), following crisis to be presented after AED had been begun initial dose of AED, time to next seizure, total seizures, dose was 9.9 days (SD+/- 6.3), being less for those receiving LEV adjustment for seizures, dose adjustments unrelated to sei- (p=0.03); mean crisis during the first 3 and 6 months was 2.9 zure control, and main side effects. The relationship between and 4, respectively. Most patients treated with LEV (N=46) re- epilepsy treatment and overall survival (OS) was evaluated.
quired less than two adjustments compared to those treated Results: The patients’ mean age was 53 years old and 56.8% with other AEDs (p=0.02). Likewise, a smaller proportion of were male. Eighty-seven (40.8%) were treated with leveti- patients exposed to LEV required the use of some coadju- racetam (LEV), 23.6% were given other AED and 31% never vant drug (p=0.04). OS was significantly higher in the group use AEDs or such information was unknown. AED was used treated with LEV compared to other AEDs (25.5 vs. 17.9-mo; following partial/total resection in 75 cases and a biopsy was carried out in 33 cases; the difference between these groups was not statistically significant (p=0.19). The requirement Conclusion: In our study patients treated with LEV had better
for using LEV and/or other AEDs was not greater in those control of epileptic crises and longer OS. w w w. r e d l a n o . o r g
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Presentaciones orales
GB-RedLANO registry 2013
Andrés Felipe Cardona 1-2, León Darío Ortiz3, Enrique Jiménez4, Fernando Hakim4, Carlos Yepes5, Nicolás Useche6, Sonia Bermúdez6, Jose Luis Asencio7, Hernán Carranza1-2, Carlos Vargas1-2, Jorge Miguel Otero1-2, Carlos Bartels4, Andrés Quintero4, Carlos E. Restrepo4, Sonia Gómez1, Laura Bernal-Vaca1, Mauricio Lema1 1 Clinical and Traslational Oncology Group, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia)2 Foundation for Clinical and Applied Cancer Research (FICMAC); associated researcher RedLANO and ONCOLGroup3 Neuro-Oncology Department, Instituto de Cancerología, Clínica Las Américas (Medellín, Colombia)4 Neurosurgery Department, Fundación Santa Fe de Bogotá (Bogotá, Colombia)5 Neurosurgery Department, Hospital Pablo Tobón Uribe (Medellín, Colombia)6 Radiology Department, Neuro-radiology Section, Fundación Santa Fe de Bogotá (Bogotá, Colombia)7 Radiology Department, Instituto Neurológico de Colombia (Medellín, Colombia)8 Hemato-Oncology Departmet, Clínica Astorga (Medellín, Colombia) Introduction: The standard treatment for Glioblastoma (GB)
extent of the surgery. 80.3% of the pts received the Stupp achieved a 14.6-mo overall survival (OS) and a 26% survival platform, 8.5% the AVAglio schema, 9.9% palliative therapy at 2 years; advances in GB care resulted in a larger propor- and 1.4% were treated with other interventions. Response tion of patients (pts) treated with bevacizumab after disease to first line therapy could be established in 191 pts (CR 13.4%; PR 36.1%; SD 13.6%; PD 29.8%). First line PFS was 6.1-mo (95%CI 3.9-12.3) and OS was 19.5-mo (95%CI 12.5- Methods: A bidirectional registry was designed to recorded
29.0). OS were greater for those suffering from secondary a large series of GB pts (n=213) treated in various institutions GBs (p=0.02), for the group that had a lower RPA (p=0.022), from Colombia throughout the last 5 years. We included the those <60-yo (p=0.04) and those having MGMT+ (p=0.03). analysis of clinical characteristics and several outcomes as In the same way, OS was significantly higher in pts treated the response rate, progression free survival (PFS) and OS.
with bevacizumab (2nd line and later; p=0.043) and in those Results: The mean age was 53-yo (SD±14.4), 56.8% (n=121) who achieved a partial or complete response after second were male and 68/175 (32%) were placed in RTOG RPA V-VI and third line (p=0.002 and p=0.009, respectively).
classes. Most pts had primary GBs (n=144), 21% had multi-centric lesions and infiltration of the corpus callosum was Conclusions: This study represented a comprehensive analy-
documented in 16.4%. Biopsy, partial and complete resec- sis of GB pts treated in Latin-America. The median PFS and OS tion were performed on 21%, 42% and 12% of patients, re- obtained from this study are comparable to previous reports.
spectively; in the remaining 25% we could not establish the w w w. r e d l a n o . o r g
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Presentaciones orales
Pyrimethamine for reverting high-grade glioma patients’ resistance to bevacizumab
Laura Bernal-Vaca 1, Andrés Felipe Cardona1-2, León Darío Ortiz3, Enrique Jiménez4, Fernando Hakim4, Nicolás Useche5, Sonia Bermúdez5, Carlos Yepes6, Hernán Carranza1-2, Carlos Vargas1-2, Jorge Miguel Otero1-2 1 Clinical and Translational Oncology Group, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia)2 Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer (FICMAC); Investigador asociado ONCOLGroup3 Instituto de Cancerología, Clínica Las Américas (Medellín, Colombia).
4 Neurosurgery Department, Fundación Santa Fe de Bogotá (Bogotá, Colombia).
5 Diagnostic Images Department, Neuro-Radiology Section, Fundación Santa Fe de Bogotá (Bogotá, Colombia)6 Neurosurgery Department, Hospital Pablo Tobón Uribe (Medellín, Colombia) Introduction: Cooper et al., noted that non-mesenchymal
overall survival (OS) rate were compared between exposed type glioblastomas (GB) become transcriptionally similar to the most aggressive neoplasias when necrosis levels in-crease, this being a notable manifestation following progres- Results: Average age was 53 years-old and 56.8% of the sub-
sion to bevacizumab. Such alterations are usually associated jects were male. Fifteen patients (7%) were given pyrimeth- with high C/EVP-b and C/EVP-g expression in hypoxic cells amine (75 mg/day with folate support) after receiving beva- from the perinecrotic niche. These two factors are strongly cizumab. Pyrimethamine did not modify second or third line associated with STAT-3 expression. Takakura et al., found treatment response rate (p=0.36 and p= 0.33, respectively) that pyrimethamine modulates STAT-dependent signalling or TTP after bevacizumab began to be used (p=0.42). Howev- routes, thereby reducing resistance to temozolamide (TMZ) er (and in spite of limited simple size), using pyrimethamine via MGMT expression, the same as after bevacizumab has had a significant impact on OS following second line treat- ment (34 months pyrimethamine use versus 17.2 months non-use; p=0.01).
Materials and methods: Data from RedLANO follow-up reg-
istry which included 213 patients was used for estimating the
Conclusions: Using pyrimethamine on high-grade glioma
pyrimethamine efficacy as coadjuvant for bevacizumab after patients following progression to bevacizumab seemed to administering second and third line in Glioblastoma. Clinical modify OS, such finding supporting its prospective evalua- characteristics, response rate, time to progression (TTP) and w w w. r e d l a n o . o r g
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Presentaciones orales
Manejo de los adenomas pituitarios agresivos y carcinomas
Luis V. Syro1, León Darío Ortiz2, Kalman Kovacs3 1 Departamento de Neurocirugía, Hospital Pablo Tobón Uribe y Clínica Medellín (Medellín, Colombia)2 Neuroncología, Instituto de Cancerología, Clínica Las Américas (Medellín, Colombia)3 Departamento de Patología, St. Michael´s Hospital (Toronto, Canadá) La mayoría de los adenomas pituitarios son lesiones benignas. Para los tumores funcionantes existen posibilidades de
manejo farmacológico. La cirugía y la radioterapia son la base del tratamiento de los adenomas no funcionantes. Aun-
que no hay una definición exacta, los tumores agresivos son aquéllos con tendencia a la recurrencia luego de la cirugía,
crecimiento rápido e invasión a las estructuras vecinas. Los carcinomas pituitarios son raros (0.2%) y su diagnóstico
se hace cuando se evidencian metástasis craneospinales o sistémicas. Su manejo incluye cirugía, radioterapia, radio-
cirugía y varios esquemas de de quimioterapia pero hasta hace poco su tratamiento era paliativo y no aumentaba la
sobrevida. La eficacia del manejo con temozolomida y bevacizumab en los adenomas pituitarios agresivos y carcinomas
ha abierto un camino con nuevas posibildades. Se hace una revisión del enfoque actual de manejo.
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Presentaciones orales
Chloroquine response in Glioblastoma patients
León Darío Ortiz 1, Andrés Felipe Cardona2-3, Enrique Jiménez4, Fernando Hakim4, Carlos Yepes5, Nicolás Useche6, Sonia Bermúdez6, José Luis Asencio7, Hernán Carranza2-3, Carlos Vargas2-3, Jorge Miguel Otero2-3 1 Instituto de Cancerología, Clínica Las Américas (Medellín, Colombia)2 Clinical and Traslational Oncology Group, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia)3 Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer (FICMAC); Investigador asociado ONCOLGroup4 Neurosurgery Department, Fundación Santa Fe de Bogotá (Bogotá, Colombia)5 Neurosurgery Department, Hospital Pablo Tobón Uribe (Medellín, Colombia)6 Diagnostic Images Department, Radiology Section, Fundación Santa Fe de Bogotá (Bogotá, Colombia)7 Diagnostic Images Department, Instituto de Neurología de Colombia (Medellín, Colombia) Introduction: Chloroquine (a pentanediamine used for
roquine did not affect the initial treatment response rate treating Plasmodium) has been shown to induce apoptosis (p=0.52) but modify positively such outcome in second line by activating p53, promoting autophagy and inhibiting the (p=0.006). In the same way Chloroquine did not modify TTP PI3K/AKT pathway in high-grade glioma cell lines. Sotelo et during the first line treatment (p=0.42). OS was 19.5 months al., demonstrated that adding chloroquine to conventional (95%CI 12.5-29.0), outcome that was not modified in favour treatment improved overall survival (OS) in glioblastoma of the chloroquine-exposed group (17.4 months vs. 20.5 months non-use; p=0.69). However, in patients with MGMT promoter methylation treated with chloroquine median OS Methods: A bidirectional registry was designed to recorded
was 20.8-mo (CI95% 17-24) versus 12.7-mo (CI95% 4.6-20) a large series of GB pts (n=213) treated in various institutions from Colombia throughout the last 5 years. We performed an indirect efficacy analysis considering Chloroquine as a Conclusions: Adding chloroquine did not lead to a positive
coadjuvant to the platform proposed by Stupp et al. Clini- effect on OS in the general population. However, it is worth cal characteristics and several outcomes as the response rate, noting that using this drug significantly modified OS in progression free survival (PFS) and OS were evaluated.
MGMT+ group and response after introducing bevacizumab. Results: The mean age was 53-yo (SD±14.4), 56.8% (n=121) Further good-quality prospective studies are required for de- were male and 68/175 (32%) were placed in RTOG RPA V-VI fining chloroquine’s real value as part of the treatment for classes. 67 patients were exposed to chloroquine and it was not used on the rest of the cohort (n=146). Using Chlo-

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