"Author Response: What constitutes activity of systemic therapy in recurrent meningioma?"
Patrick Y.Wen, Professor of Neurology, Harvard Medical SchoolPatrick_Wen@dfci.harvard.edu
Andrew D. Norden, Boston, MA
Submitted May 27, 2015
We appreciate Dr. Chamberlain's thoughtful comments and interest in our study. [1] He questioned our conclusion that further study of pasireotide LAR in recurrent meningioma is unwarranted.
The conclusion was based on the observation of a low 6-month progression-free survival proportion (PFS6) in the atypical/malignant meningioma cohort, which was 17% in comparison to published studies showing PFS6 of 26% (95% CI: 19%-33%). [2] Although a PFS6 in the benign meningioma cohort is larger than the reported 29% (95% CI: 20%- 38%), we feel that the conclusion was justified when one considers the atypical/malignant cohort results and the overall small sample size. It should be noted that fewer than 70% of patients in the benign meningioma cohort were treated with radiation therapy, which may suggest that this selected cohort had particularly slow-growing lesions and might not meet criteria for progression over a 6-month interval, even without additional treatment. Furthermore, there was not a compelling rationale to hypothesize that the agent was more effective in benign meningiomas than atypical/malignant ones.
1. Norden AD, Ligon KL, Hammond SN, et al. Phase II study on monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma. Neurology 2015;84:280-296.
2. Kaley T, Barani I, Chamberlain M, et al. Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review. Neuro Oncol 2014;16:829-840.
For disclosures, please contact the editorial office at journal@neurology.org.
We appreciate Dr. Chamberlain's thoughtful comments and interest in our study. [1] He questioned our conclusion that further study of pasireotide LAR in recurrent meningioma is unwarranted.
The conclusion was based on the observation of a low 6-month progression-free survival proportion (PFS6) in the atypical/malignant meningioma cohort, which was 17% in comparison to published studies showing PFS6 of 26% (95% CI: 19%-33%). [2] Although a PFS6 in the benign meningioma cohort is larger than the reported 29% (95% CI: 20%- 38%), we feel that the conclusion was justified when one considers the atypical/malignant cohort results and the overall small sample size. It should be noted that fewer than 70% of patients in the benign meningioma cohort were treated with radiation therapy, which may suggest that this selected cohort had particularly slow-growing lesions and might not meet criteria for progression over a 6-month interval, even without additional treatment. Furthermore, there was not a compelling rationale to hypothesize that the agent was more effective in benign meningiomas than atypical/malignant ones.
1. Norden AD, Ligon KL, Hammond SN, et al. Phase II study on monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma. Neurology 2015;84:280-296.
2. Kaley T, Barani I, Chamberlain M, et al. Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review. Neuro Oncol 2014;16:829-840.
For disclosures, please contact the editorial office at journal@neurology.org.