Patient Oriented Research Program in Neuro-oncology

以患者为中心的神经肿瘤学研究计划

• 批准号: 8846550
• 负责人: VINAY K PUDUVALLI
• 金额: $ 7.23万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-13 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8846550
• 关键词: 19q; Aggressive course; Angiogenesis Inhibitors; Angiogenic Proteins; Apoptosis; Area; Basic Science; Biological Markers; Biological Process; Biology; Blood Volume; Brain Neoplasms; Bypass; Cancer Center; Cell Death; Cell Differentiation process; Cerebrovascular Circulation; Chromatin; Clinical; Clinical Research; Clinical Trials; Clinical Trials Design; Collaborations; Critical Pathways; DNA; DNA Structure; Data; Development; Diffusion; Disease; Endothelial Cells; Epigenetic Process; Faculty; Fellowship Program; Funding; Gene Expression; Glioblastoma; Glioma; Goals; Grant; Growth Factor Inhibition; Histone Deacetylase Inhibitor; Human; Incidence; Investigation; Laboratories; Laboratory Research; Laboratory Study; MGMT gene; MRI Scans; Magnetic Resonance Imaging; Malignant - descriptor; Malignant Glioma; Malignant Neoplasms; Measurement; Measures; Mentors; Mentorship; Mesenchymal; Methods; Methylation; Molecular; Morbidity - disease rate; Mutation; Neurologic; Neurology; Oncologist; Outcome; Pathway interactions; Patients; Perfusion; Physicians; Platelet-Derived Growth Factor; Prediction of Response to Therapy; Primary Brain Neoplasms; Principal Investigator; Process; Progression-Free Survivals; Randomized; Recurrence; Regulation; Relative (related person); Research; Research Personnel; Research Training; Resistance; Resistance development; Resources; Role; Route; Scientist; Serum; Structure; Testing; Therapeutic; Time; Tissues; Training; Translational Research; Translations; Treatment Failure; Treatment outcome; Tumor Biology; Vascular Endothelial Growth Factors; Vorinostat; angiogenesis; arm; base; bevacizumab; career; clinical care; conventional therapy; design; experience; humanized antibody; hypoxia inducible factor 1; improved; insight; interest; member; mortality; neuro-oncology; novel; novel strategies; novel therapeutics; oligodendroglioma; oncology; outcome forecast; overexpression; patient oriented; patient oriented research; pre-clinical; preclinical study; prevent; programs; promoter; research study; response; screening; translational study; treatment response; trial design; tumor

DESCRIPTION (provided by applicant): The treatment of primary brain tumors poses a particularly formidable challenge in the field of oncology given its aggressive course and resistance to conventional therapies. To effectively generate paradigm-shifting therapeutic approaches against brain tumors, a rapid translation of high impact laboratory research findings into well constructed clinical trials is needed. As a mid-career physician scientist and researcher, I have successfully conducted basic research in the laboratory providing insights into biology of brain tumors and seamlessly moved these ideas into clinical trials against brain tumors; This has been possible due to my training in basic research and experience in clinical care in both neurology and neuro-oncology, which allow me to specifically conduct patient-oriented research related to neurological malignancies. In addition, I have taken a proactive role in mentoring neuro-oncology fellows as the former director of Neuro-oncology fellowship program. My current role as director of Clinical Research provides me with the unique opportunity to combine patient oriented research with focused mentoring. The K24 grant will provide protected time and resources to expand my clinical research efforts into epigenetics of brain tumors, which has emerged as a new area of interest based on my laboratory studies. Epigenetics pertains to the changes in gene expression not due to change in the DNA but due to alterations of control mechanisms that regulate the structure and access to chromatin. In disease processes such as cancer, epigenetic changes can dramatically influence tumor biology, response to therapy and prediction of outcome; one such effect, MGMT promoter methylation, is already known to influence the outcome of glioblastoma (GBM), the most aggressive of primary brain tumors. Recently, bevacizumab, a humanized antibody that blocks vascular endothelial growth factor (VEGF) and prevents neoangiogenesis has shown efficacy against recurrent GBM and is approved for this indication. Although initially effective, tumors adapt to VEGF inhibition and bypass this blockade through several mechanisms leading to recurrence. Epigenetic factors leading to altered gene expression have been shown to reverse this resistance in preclinical studies by inhibiting the escape routes including non-VEGF molecular pathways such as overexpression of HIF1¿, PDGF and IGF as well as recruitment of circulating endothelial cells. The short term goal of this project is to conduct a clinical trial to test the hypothesis that vorinostat, which epigenetically changes DNA structure, can prevent the development of resistance to bevacizumab in patients with recurrent glioblastoma and significantly delay tumor recurrence and improve survival. This trial is unique in that a new statistical design based on Bayesian adaptive randomization methods will allow us to compare the combination of bevacizumab and vorinostat with bevacizumab alone in an efficient "pick the winner" design. The study is also designed to include DCE/DSC MR imaging to measure changes in perfusion and diffusion within the tumor as a noninvasive marker of treatment outcome. It also includes serum biomarker measurements to determine their association with outcome. The study will provide both new insights into overcoming resistance to antiangiogenic agents and test novel trial designs; it will also provide me with an excellent opportunity for mentorship of fellows and junior faculty in the conduct of trial design and rational targeting of gliomas. Mentoring fellows and junior faculty is one of my major goals under this grant and I will actively involve neuro-oncology fellows in the various projects involving epigenetic laboratory research and clinical trials; my efforts will also be specifically directed towards guidance of junior faculy in their own projects with a goal to move them to an independent academic path. The long term goal of this project is to develop a comprehensive strategy towards a Brain Tumor Epigenetics Program within the Brain Tumor Center that will support studies of epigenetic factors influencing tumor biology in various areas of research and training and consequently develop novel approaches to brain tumor therapy.

描述(申请人提供)：原发脑肿瘤的治疗在肿瘤学领域是一个特别艰巨的挑战，因为它具有侵略性的过程和对传统疗法的抵抗力。为了有效地产生针对脑瘤的范式转换治疗方法，需要将高影响力的实验室研究结果快速转化为精心构建的临床试验。作为一名职业生涯中期的内科科学家和研究人员，我成功地在实验室进行了基础研究，提供了对脑瘤生物学的见解，并将这些想法无缝地应用到针对脑瘤的临床试验中；这要归功于我在神经学和神经肿瘤学方面的基础研究培训和临床护理经验，这使我能够专门进行与神经恶性肿瘤相关的面向患者的研究。此外，作为神经肿瘤研究员项目的前主任，我在指导神经肿瘤研究员方面发挥了积极的作用。 我目前作为临床研究主任的角色为我提供了将以患者为中心的研究与重点指导相结合的独特机会。K24拨款将提供受保护的时间和资源，将我的临床研究努力扩展到脑肿瘤的表观遗传学，这已经成为基于我的实验室研究的一个新的感兴趣的领域。表观遗传学与基因表达的变化有关，不是由于DNA的变化，而是由于调节结构和获得染色质的控制机制的改变。在癌症等疾病过程中，表观遗传学变化可以极大地影响肿瘤生物学、治疗反应和预后预测；其中一种效应，MGMT启动子甲基化，已被认为影响胶质母细胞瘤(GBM)的预后，胶质母细胞瘤是最具侵袭性的脑肿瘤。最近，贝伐单抗，一种人源化抗体，阻断血管内皮生长因子(VEGF)，防止新的血管生成，显示出对复发的GBM的疗效，并被批准用于这一适应症。虽然最初是有效的，但肿瘤会适应血管内皮生长因子的抑制，并通过几种导致复发的机制绕过这种阻断。在临床前研究中，导致基因表达改变的表观遗传因素已被证明通过抑制包括非血管内皮生长因子分子途径在内的逃逸途径，如HIF1、PDGF和IGF的过度表达以及循环内皮细胞的募集来逆转这种耐药性。 该项目的短期目标是进行一项临床试验，以检验这样一种假设，即通过表观遗传改变DNA结构的伏立诺可以防止复发的胶质母细胞瘤患者对贝伐单抗产生耐药性，并显著推迟肿瘤的复发和提高存活率。这项试验的独特之处在于，基于贝叶斯自适应随机化方法的新统计设计将使我们能够比较贝伐单抗和涡旋单抗的组合以及贝伐单抗在有效的“挑选赢家”设计中的作用。这项研究还包括DCE/DSC磁共振成像，以测量肿瘤内血流和扩散的变化，作为治疗结果的非侵入性标记。它还包括血清生物标记物测量，以确定它们与预后的关系。这项研究将为克服抗血管生成药物的耐药性和测试新的试验设计提供新的见解；它还将为指导研究员和初级教员进行胶质瘤的试验设计和合理靶向提供一个极好的机会。 指导研究员和初级教员是我在这笔拨款下的主要目标之一，我将积极让神经肿瘤学研究员参与各种涉及表观遗传学实验室研究和临床试验的项目；我的努力也将专门针对指导初级教师在他们自己的项目中，目标是推动他们走上一条独立的学术道路。 该项目的长期目标是为脑瘤中心内的脑瘤表观遗传学计划制定一个全面的战略，以支持在研究和培训的各个领域对影响肿瘤生物学的表观遗传因素的研究，从而开发脑瘤治疗的新方法。