Long-term survivors of glioblastoma: Tumor molecular, clinical, and imaging findings

Nicole Briceno; Elizabeth Vera; Edina Komlodi-Pasztor; Zied Abdullaev; Anna Choi; Ewa Grajkowska; Tricia Kunst; Jason Levine; Matthew Lindsley; Kelly Fernandez; Jennifer Reyes; Lisa Boris; Eric Burton; Marissa Panzer; Lily Polskin; Marta Penas-Prado; Tina Pillai; Brett J Theeler; Jing Wu; Kathleen Wall; Antonios Papanicolau-Sengos; Martha Quezado; James Smirniotopoulos; Kenneth Aldape; Terri S Armstrong; Mark R Gilbert

doi:10.1093/noajnl/vdae019

Long-term survivors of glioblastoma: Tumor molecular, clinical, and imaging findings

Neurooncol Adv. 2024 Feb 8;6(1):vdae019. doi: 10.1093/noajnl/vdae019. eCollection 2024 Jan-Dec.

Authors

Nicole Briceno¹, Elizabeth Vera¹, Edina Komlodi-Pasztor¹, Zied Abdullaev², Anna Choi¹, Ewa Grajkowska¹, Tricia Kunst¹, Jason Levine³, Matthew Lindsley¹, Kelly Fernandez¹, Jennifer Reyes¹, Lisa Boris⁴, Eric Burton¹, Marissa Panzer¹, Lily Polskin¹, Marta Penas-Prado¹, Tina Pillai¹, Brett J Theeler¹, Jing Wu¹, Kathleen Wall¹, Antonios Papanicolau-Sengos², Martha Quezado², James Smirniotopoulos^{5

6}, Kenneth Aldape², Terri S Armstrong¹, Mark R Gilbert¹

Affiliations

¹ Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
² Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
³ Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁴ Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, Maryland, USA.
⁵ George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
⁶ MedPix, National Library of Medicine, Bethesda, Maryland, USA.

Abstract

Background: Glioblastoma (GBM) is the most aggressive primary brain malignancy with <45% living a year beyond diagnosis. Previously published investigations of long-term survivors (LTS) provided clinical data but rarely incorporated a comprehensive clinical and molecular analysis. Herein, we identify clinical, imaging, molecular, and outcome features for 23 GBM-LTS patients and compare them with a matched cohort of short-term survivors (STS).

Methods: Molecularly confirmed Isocitrate Dehydrogenase (IDH) wildtype GBM patients living ≥3 years post-diagnosis (N_LTS = 23) or <3 years (N_STS = 75) were identified from our Natural History study. Clinical and demographic characteristics were compared. Tumor tissue was analyzed with targeted next generation sequencing (NGS) (N_LTS = 23; N_STS = 74) and methylation analysis (N_LTS = 18; N_STS = 28). Pre-surgical MRI scans for a subset of LTS (N = 14) and STS control (N = 28) matched on sex, age, and extent of resection were analyzed.

Results: LTS tended to be younger. Diagnostic MRIs showed more LTS with T1 tumor hypointensity. LTS tumors were enriched for MGMTp methylation and tumor protein 53 (TP53) mutation. Three patients with classic GBM histology were reclassified based on NGS and methylation testing. Additionally, there were LTS with typical poor prognostic molecular markers.

Conclusions: Our findings emphasize that generalized predictions of prognosis are inaccurate for individual patients and underscore the need for complete clinical evaluation including molecular work-up to confirm the diagnosis. Continued accrual of patients to LTS registries that containcomprehensive clinical, imaging, tumor molecular data, and outcomes measures may pro\vide important insights about individual patient prognosis.

Keywords: glioblastoma; long-term survivor; methylation; predictors.

Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.