Ependymoma Sunrise Session Summary from the Annual SNO Meeting

— Categories: Press Release     Posted on December 15, 2010

Members from the CERN Foundation were able to present an hour long discussion on ependymoma during the Society for Neuro-Oncology 15th Annual Meeting that was held in Montreal, Canada. The speakers included Dr. Terri Armstrong, Dr. Mark Gilbert, Dr. Richard Gilbertson, and Dr. Ken Aldape.

The agenda for the session was as follows: 

  • Introduction to the CERN Foundation and overview of Outcomes Projects, Dr. Terri Armstrong
  • The CERN Foundation Clinical Trials Portfolio, Dr. Mark Gilbert
  • Translating Biologic Insights Into New Treatments of Ependymoma, Dr. Richard Gilbertson
  • Expression Subtypes of Posterior Fossa Ependymoma, Dr. Ken Aldape

Dr. Armstrong opened with a brief overview of the CERN Foundation and mentioned its creation was a result of a patient meeting back in 2006. The CERN Foundation breaks institutional barriers and leverages key discoveries from both the pediatric and adult community by frequent communication and commitment from its members. The recently expanded five main projects of the CERN Foundation are interrelated and together allow the CERN Foundation to accomplish its mission. The projects include Clinical Trials; Pathology and Molecular Profiling; Pharmacology and Developmental Therapeutics; Tumor Stem Cell and Laboratory Models; and Patient Outcomes and Education. Dr. Armstrong continued to discuss the Ependymoma Outcomes (EO) Project and presented data collected by over 110 adult ependymoma patients, including information on patterns of care and treatment and current health status.

Complete results to date can be found by visiting the results page in the EO Project section of the CERN website. The EO Project has recently expanded to include the pediatric population. If you have not already participated in the EO Project, please do so today.

Following the Dr. Armstrong’s presentation, Dr. Gilbert presented an overview of the traditional first line treatment of patients with ependymoma. This typically includes surgical resection followed by radiation and then chemotherapy. He then presented data and facts that we know about the biology of ependymoma, specifically the molecular targets that are important in the cancer cells that promote growth, expansion and development of a new blood supply. These “targets” help us to choose therapies based on the pathways that allow the drug(s) to attack the tumor. This laid the foundation for the drug choices of the first adult and pediatric clinical trials. CERN 08-01 is a clinical trial for pediatric patients with ependymoma that has regrown despite surgery, radiation and prior chemotherapy. This treatment regimen combines the anti-angiogenic agent bevacizumab with the molecular pathway blocking agent, lapatinib. CERN 08-02 is for adult patients with regrowing (recurrent) ependymoma of the brain or spinal cord. This clinical trial combines temozolomide, a commonly used agent for other brain tumors, with the agent lapatinib as with the pediatric study. Accrual is ongoing at both the Pediatric and Adult CERN Clinical Trial Sites.

Dr. Gilbert also presented information for future clinical trials that are truly a product of the synergy of the CERN Foundation. The first trials were chosen based off the information we had at the time as well as the compounds (or drugs) available. Additionally, adult patients with ependymoma can participate in the ongoing Delta-24 virus study that is accruing patients at MD Anderson. Patients on the study have this unique virus injected into tumor. The virus is designed so it can only enter and grow in tumor cells with the result that the tumor cells die. Additionally, we are working on generating a second generation of trials, choosing the treatments chosen based on data generated by Projects 3&4. In the near future we expect to open an adult trial using Berubicin, a novel therapy developed by our drug discovery team, and 5FU, and existing drug chosen as a result of the drug screening technique. We hope to have both of these trials open in 2011 at all CERN Centers.

The next presentation was the Project 3 & 4 discussion given by Dr. Richard Gilbertson. He does a wonderful job of presenting complex science in an easy to understand manner. The first topic of importance was the issue of ependymoma stem cells. Dr. Gilbertson’s lab has shown that ependymoma tumors arise from specific kinds of neural stem cells in the brain. They demonstrated this by replicating the disease from these cells in mice. Additionally, his lab has shown that there are nine different subgroups of ependymoma that are likely to arise from different types of stem cells. This is extremely important information as we seek to develop models that help to test compounds pre-clinically (before given to patients).

Dr. Gilbertson has successfully produced a model one form of human ependymoma, termed “subgroup D” and efforts to create the remaining eight models are underway. With these models we should be able to understand why certain patients respond to therapies and why some do not. Ultimately, we will use these models to design specific therapies for each subtype of ependymoma. The Gilbertson lab is working closely with Dr. Guy at St. Jude Children’s Research Hospital to use the model to screen thousands of new compounds to identify new treatments for ependymoma.

Finally, Dr. Ken Aldape, a well known and respected pathologist, gave an insightful overview on the progress made regarding the diagnosis of ependymoma and where the future is headed. One very interesting area of discussion was focused on some of the challenges in making a diagnosis of ependymoma. He mentioned that ependymoma diagnosis can be at times complex and the criteria for grading of tumors controversial and subjective. This presents a challenge for patients and clinicians and therefore we need better mechanisms to provide accurate and reliable diagnosis. Dr. Aldape explained that even though ependymoma looks the same under the microscope (and he should know considering he has viewed hundreds if not thousands of ependymoma slides!), they can be very different on a molecular level relating to where the tumor originated. Otherwise stated, the biology or cellular make-up can be totally different. To give you a specific example, three anaplastic ependymoma (Grade 3) tissue samples can each belong to three different ependymoma subtypes. We need to advance the molecular analysis in order to use this data to predict outcome rather than grading. This is a very important summary from Project 2 and you can see how it relates to the work Dr. Gilbertson and team is doing in Project 3 and 4.

In closing, the CERN Foundation is thankful to SNO for supporting this type of educational session and providing the foundation with a platform to educate professionals about ependymoma. We are also appreciative of the people who attended the session and who are also dedicated to helping patients with ependymoma. The CERN Foundation is extremely proud of all the work that has been accomplished in the short time span since the conception of the foundation in 2006.

To learn more about the Society for Neuro-Oncology (SNO), visit soc-neuro-onc.org for more information.

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