Head: Andrea Pace, MD
The research activity of Neurology Unit is focused on several topics. These include:
- Clinical neuro-oncology - The role of chemotherapy in recurrent malignant brain tumor has been evaluated in phase II trials exploring the activity and toxicity of several anticancer agents: temozolomide, fotemustine, bevacizumab, carboplatin, regorafenib. Recent trials have been launched including: weekly carboplatin AUC2 in recurrent malignant glioma; cloropromazine associated to temozolomide in newly diagnosed GBM.
- Traslational research - Next generation sequencing in glioma patients for identification of potential target therapy: NGS panels assessment allowing the simultaneous analysis of both DNA and RNA in order to identify either the presence of point variants and fusion genes or variations in the number of gene copies with a panel of 50 genes that are recognized to have a key role in tumour development, with the aim to identify potential therapeutic target
- Cognitive impairment assessment and rehabilitation - The role of cognitive rehabilitation programs has been investigated in different setting of care (in patients, outpatients, home care setting). Preliminary data showed beneficial effects of a computer-based cognitive rehabilitation programme and positive impact on Quality of Life in neuro-oncological patients. Preliminary results have been presented in national and international scientific meetings.
- Home-care for brain tumor patients - The efficacy of a program of comprehensive palliative care for brain tumour patients supported by the Lazio Regional Health System was evaluated analyzing place of death, caregiver satisfaction, re-hospitalization rate and the impact on Health System costs. The results of this project have been presented in national and international scientific meeting.
- Palliative neuro oncology and telemedicine. We developed a health WEB site portal applied to Neuro-Oncology supportive and palliative care issues (www.portaleneuroncologia.it). Neuroncology Unit of IRE is involved in an international project aimed to define guidelines and treatment recommendations on supportive and palliative care in brain tumor patients. The guidelines produced by the palliative care task force have been recently published on Lancet Oncology.
- Peripheral neurotoxicity of anticancer drugs - We are involved in an international study: The Chemotherapy-Induced Peripheral Neuropathy Outcome Measures Standardization (CIPerinoms) including 20 European and US oncology and neurology centres specifically designed to compare the validity and reliability of different methods proposed for the assessment of chemotherapy-induced peripheral neuropathy in a formal way. The results have been published on Annals of Oncology, European Journal of Cancer and Journal of Peripheral Nervous System.
- Rehabilitation in Oncology - Neuroncology Unit research activity includes the clinical research and methodological assessment of rehabilitation strategies in oncology. The definition of the role of rehabilitation in different setting of care (early rehabilitation of anticancer treatment sequelae; long term survivors rehabiltation needs, palliative rehabilitation) is the main object of several research projects.
- Role of comorbidities in the elderly glioblastoma - A prospective study: This study evaluated the impact of comorbidities on outcomes in elderly GBM patients. Comorbid conditions were indentified with the modified version of the Cumulative Illness Rating Scale (CIRS). The results showed that comorbidities play an important prognostic role in elderly with GBM. Preliminary results have been presented in national and international scientific meetings. The final results have been published in 2019.
- The prognostic value of pyrosequencing-detected MGMT-promoter hypermethylation in newly diagnosed patients with glioblastoma - We collected tumour samples of GBM patients who underwent surgery or biopsy and were/are followed at the Neuro-oncology Unit of National Cancer Institute Regina Elena. Preliminary data showed that patients with a cut-off <35% of methylation had a shorter PFS but not significant difference we observed in terms of overall survival. A multicentric study, with the participation of Italian neuroncology centers, on the methylation status of glioblastoma determined with pyrosequencing is ongoing.
- Headache as a presenting symptom of glioma: a cross-sectional study. Five hundred and twenty-seven patients were interviewed; 66 (12.5%) of them had headache as a presenting symptom of brain tumour. In our sample, headache resembled a tension-type headache in 31 patients (6% of all glioma cases) and the classic benign thunderclap headache (BTH) was found in 28 cases (5% of all glioma cases). The paper has been submitted for publication.
- Tumor related Epilepsy - The Center of Tumor-related Epilepsy is Coordinator of Italian League Against Epilepsy (LICE) Study Group on “Brain tumor-related Epilepsy”. This group includes 35 Italian epilepsy centers.
The CET is one of the only 4 European Centers, and the only Italian member, included in the world network on Tumor Epilepsy, the International Brain Tumor-Related Epilepsy Research Consortium: http://tumorepilepsy.com/index.html
Ongoing Clinical Trials
- Glioma Project: Glioma, aspetti biomolecolari dal tessuto alla Radiomica. Traslational study. Ongoing
- Definizione dei temi rilevanti per le cure palliative nei pazienti affetti da neoplasia cerebrale e loro caregivers. (studio ancillare per la produzione di Linee Guida Nazionali Italiane sulle cure palliative in neuroncologia). Ongoing
- Rational drug repositioning for an efficient and safe combined therapeutic approach to glioblastoma multiforme. Antipsicotic chlorpromazine in combination with temozolomide in first line treatment of un-methylated Glioblastoma patients. A multicentric phase II trial. Ongoing
- Coagulation/complement activation and cerebral hypoperfusion in relapsing-remitting multiple sclerosis. MoH project. In collaboration with Università di Roma La Sapienza and with Icahn School of Medicine at Mount Sinai, New York, NY, United States. Ongoing
- Valutazione del valore predittivo dei biomarkers ematochimici trombofilici metabolici ed infiammatori pre-operatori per complicanze post-operatori e per sopravvivenza in pazienti affetti da glioma e da metastasi cerebrali - studio osservazionale retrospettivo. Ongoing
- A model of comprehensive care and tele-health in brain tumor related epilepsy patients. Ongoing
- Studio clinico-neuropatologico-molecolare di pazienti affetti da glioblastoma lungo-sopravviventi. Multicentric study (ACC). Ongoing
- Revision of the module ‘EORTC QLQ-BN20’: Phase I-III. EORTC QoL group. Ongoing
- Neurotoxicity prevention with nutracetics in myeloma patients treated with Bortezomib. A Pilot Study. Ongoing
- Efficacy and tolerability of low dose vs standard doses of AEDs in newly diagnosed epileptic patients (STANDLOW). Multicentric, randomized trial.
- Studio prospettico osservazionale multicentrico sulle complicanze neurologiche indotte da checkpoint inhibitors.