Marlon Saria

MicroRNAs in cerebrospinal fluid identify glioblastoma and metastatic brain cancers and reflect disease activity

An accurate, nonsurgical diagnostic test for brain tumors is currently unavailable, and the methods of monitoring disease progression are not fully reliable. MicroRNA profiling of biological fluids has recently emerged as a diagnostic tool for several pathologic conditions. Here we tested whether microRNA profiling of cerebrospinal fluid (CSF) enables detection of glioblastoma, discrimination between glioblastoma and metastatic brain tumors, and reflects disease activity. We determined CSF levels of several cancer-associated microRNAs for 118 patients diagnosed with different types of brain cancers and nonneoplastic neuropathologies by quantitative reverse transcription PCR analysis. The levels of miR-10b and miR-21 are found significantly increased in the CSF of patients with glioblastoma and brain metastasis of breast and lung cancer, compared with tumors in remission and a variety of nonneoplastic conditions. Members of the miR-200 family are highly elevated in the CSF of patients with brain metastases but not with any other pathologic conditions, allowing discrimination between glioblastoma and metastatic brain tumors. Quantification of as few as 7 microRNAs in CSF enables differential recognition of glioblastoma and metastatic brain cancer using computational machine learning tools (Support Vector Machine) with high accuracy (91%-99%) on a test set of samples. Furthermore, we show that disease activity and treatment response can be monitored by longitudinal microRNA profiles in the CSF of glioblastoma and non-small cell lung carcinoma patients. This study demonstrates that microRNA-based detection of brain malignancies can be reliably performed and that microRNAs in CSF can serve as biomarkers of treatment response in brain cancers.

Retrospective analysis of the tolerability and activity of lacosamide in patients with brain tumors: clinical article.

OBJECT The object of this study was to determine the tolerability and activity of lacosamide in patients with brain tumors. METHODS The authors reviewed the medical records at 5 US academic medical centers with tertiary brain tumor programs, seeking all patients in whom a primary brain tumor had been diagnosed and who were taking lacosamide. RESULTS The authors identified 70 patients with primary brain tumors and reviewed seizure frequency and toxicities. The majority of the patients had gliomas (96%). Fifty-five (78%) had partial seizures only, and 12 (17%) had generalized seizures. Most of the patients (74%) were started on lacosamide because of recurrent seizures. Forty-six patients (66%) reported a decrease in seizure frequency, and 21 patients (30%) reported stable seizures. Most of the patients (54 [77%]) placed on lacosamide did not report any toxicities. CONCLUSIONS This retrospective analysis demonstrated that lacosamide was both well tolerated and active as an add-on antiepileptic drug (AED) in patients with brain tumors. Lacosamides novel mechanism of action will allow for concurrent use with other AEDs, as documented by its activity across many different types of AEDs used in this patient population. Larger prospective studies are warranted.

Novel approaches to treating leptomeningeal metastases

Leptomeningeal metastasis is a devastating complication of the central nervous system in patients with late-stage solid or hematological cancers. Leptomeningeal metastasis results from the multifocal seeding of the leptomeninges by malignant cancer cells. Although central nervous system metastasis usually presents in patients with widely disseminated and progressive late-stage cancer, malignant cells may spread to the cerebrospinal fluid during earlier disease stages in particularly aggressive cancers. Treatment of leptomeningeal metastasis is largely palliative but will often provide stabilization and protection from further neurological deterioration and improve quality of life. There is a need to raise awareness of the impact of leptomeningeal metastases on cancer patients and its known and putative biological basis. Novel diagnostic approaches include identification of biomarkers that may stratify the risk for developing leptomeningeal metastasis. Current therapies can be used more effectively while waiting for advanced treatments to be developed.

Hematopoietic stem cell transplantation: implications for critical care nurses.

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in the treatment of malignant and nonmalignant diseases. The treatment modality has been proven effective but is not without risks. Studies consistently have identified the need for advanced supportive care (e.g., multiple organ dysfunction, vasopressor use, mechanical ventilation) as a negative prognostic indicator in patients who have received HSCT. Among patients who have received HSCT, 15%-40% require critical care monitoring or advanced support. Nurses on intensive care units can positively impact outcomes for transplant recipients when they possess the specialized skills to recognize and promptly intervene when transplant-related complications arise. This article will provide a basic overview of the HSCT process and outline the complications that may necessitate transfer to a higher level of care for specialized skills and equipment in the intensive care setting.

Cerebral syphilitic gumma: a case report and review of the literature

A 45-year-old male presented with subacute onset of a right-sided hemiparesis, right homonymous hemianopsia, and slurred speech. The brain imaging revealed two separate intraparenchymal enhancing lesions. The cerebrospinal fluid rapid plasma reagin and venereal disease research laboratory test were positive and consistent with syphilitic gumma, and the patient responded dramatically to penicillin G. Despite, currently low incidence of syphilis; CNS gummas should be in the differential of mass lesions as they are eminently treatable.

Topical thalidomide gel in oral chronic GVHD and role of in situ cytokine expression in monitoring biological activity

Topical thalidomide gel in oral chronic GVHD and role of in situ cytokine expression in monitoring biological activity

Preventing and Managing Infections in Neutropenic Stem Cell Transplantation Recipients: Evidence-Based Review

The number of hematopoietic stem cell transplantations (HSCTs) performed annually is increasing. Although general survival rates have risen since 1990, mortality and morbidity from preventable complications can be improved. As a result, this article will review developments in preventing and managing infections in neutropenic HSCT recipients.

Current Perspectives in the Management of Brain Metastases.

Brain metastases (BMs) are diagnosed in 10%-40% of all patients with cancer, and the incidence continues to increase along with the number of long-term survivors. When BMs occur, they are often associated with a myriad of symptoms, including neurologic dysfunction and functional decline; both are difficult to manage and can be distressing for patients and their caregivers. Although clinically significant findings have not kept up with the rapid pace of scientific breakthroughs in understanding the mechanisms of BMs, novel approaches that affect the prognosis of patients with BMs have been introduced in clinical practice. At a Glance • Screening for brain metastases (BMs) is not routinely performed in patients with no neurologic symptoms. However, screening is indicated in lung cancer and possibly in the context of high-risk cancers. • Individual differences in patients warrant a personalized approach in the management of BMs. • Whole brain radiation therapy and steroids are considered to be the cornerstones of treatment for BMs.

Efficacy and Safety of Treating Glioblastoma With Tumor-Treating Fields Therapy.

BACKGROUND Glioblastoma (GBM) is a highly aggressive astrocytoma with a dismal prognosis. Since 1976, only three chemotherapeutic agents have been approved for the treatment of GBM. Tumor-treating fields (TTFields) therapy, delivered via a noninvasive device, is a new therapy approved for use in patients with recurrent GBM and in combination with temozolomide for the treatment of newly diagnosed GBM. OBJECTIVES This article reviews the mechanism of action and findings from preclinical and clinical studies supporting the use of TTFields for patients with newly diagnosed and recurrent GBM. METHODS This article provides an overview of published literature on the efficacy and safety of treating GBM with TTFields. FINDINGS For the first time in more than a decade, patients with GBM have a noninvasive treatment option that has been shown to increase progression-free survival and overall survival with minimal adverse events.

Voices of Oncology Nursing Society Members Matter in Advocacy and Decisions Related to U.S. Health Policy

The Oncology Nursing Society (ONS), a member of the Nursing Organizations Alliance, invests in advocating for health and public policy decisions by sending members to the Nurse in Washington Internship (NIWI) program annually. NIWI provides a forum to educate nurses on the legislative process, giving attendees a better understanding of political, legislative, and regulatory issues facing nurses. The 2014 ONS delegation participated in training and lobbying focused on federal funding issues, nursing education, workforce oversight, and funding for nursing research. The three-day program ended with a Capitol Hill visit where nurses met with their respective legislators or their staff, using skills learned at NIWI briefings to influence policy for nurses and the patients they serve. Critical health and public policy decisions affecting nurses, their practice, and their patients require participation in and understanding of the legislative process. This article provides a glimpse into the three-day experience of the delegates attending the 2014 NIWI.