REPORT FOR THE IBTA E-NEWSLETTER ON THE 

2010 BRITISH NEURO-ONCOLOGY SOCIETY

CONFERENCE 

GLASGOW, UK       23 – 25 June 2010

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The British Neuro-Oncology Society’s (BNOS) annual meeting was held from 23 to 25 June in Glasgow, Scotland.  The current BNOS President is Charles Davis (consultant neurosurgeon, Preston, UK) and the Vice-President is Geoff Pilkington (Professor of Cellular and Molecular Neuro-oncology, Portsmouth, UK.)

Just over 240 clinicians, researchers, specialist neuro-oncology nurses and representatives of patient groups (Brain Tumour UK, Samantha Dickson Brain Tumour Trust, Brain Tumour Research, Brainstrust, Hammer Out, Brain Tumour Research Campaign, Brain Tumour Action, International Brain Tumour Alliance) attended.  There was also an exhibition by patient groups and industry.

The conference was held at the Wolfson Medical School Building at the University of Glasgow.  Accommodation was at the nearby student housing site of Queen Margaret Residences.

“Collaboration and Teamwork” was the theme of this year’s BNOS conference and the meeting kicked off on Wednesday, 23rd June with a postgraduate symposium on “Succeeding in Neuro-oncology research” which was sponsored by Brain Tumour Research (formerly the United Brain Tumour Campaign).

This was followed by a special afternoon symposium in honour of Professor Roy Rampling (Beatson, Glasgow) who had officially retired a few weeks earlier.

Various key figures from the international brain tumour professional community gave lectures in honour of Professor Rampling.

Martin van den Bent (Rotterdam, The Netherlands) spoke on “RANO: outcome assessment in the era of pseudos”.  Manfred Westphal (Hamburg, Germany) spoke on the development of neurosurgical therapies. David Ellison (Memphis, USA) talked about the clinical, pathological and molecular variables of medulloblastoma as they might potentially relate to stratification models. Robin Grant (Edinburgh, UK) spoke on “Relieving All Medical Problems Lingering IN Glioma – a neurologist’s thoughts.”  The title of Dr Grant’s presentation, in which he discussed common neurological problems associated with glioma (including epilepsy, depression and cognitive difficulties) cleverly formed an acronym of “RAMPLING”. 

Scientific sessions began the following morning with a breakfast symposium, chaired by Professor John Darling (Wolverhampton), on “Achieving greater access to tissue in neuro-oncology research”.  Views on this were expressed in presentations from two UK-based neuropathologists, Professor Peter Collins (Cambridge) and Dr Tim Dawson (Preston). The patients’ and caregivers’ views were presented by Kathy Oliver of the International Brain Tumour Alliance (IBTA).  

Reactions to the thoughts expressed in the IBTA presentation were very good, although there were differing opinions on the IBTA’s point about genetic information discovered in the course of research on a particular patient’s brain tumour tissue being released to that patient should he wish to have that information. 

The IBTA feels strongly on this subject and the following relevant section has been included in the recently released Charter of Brain Tumour Patients' Rights:

"(12) I have the right to be given copies of all my medical records, including radiology reports, pathology reports, both histopathology and genetic analysis, and digital copies of all my scans if that process is available. If I have donated tissue or any other bio-specimen for research or clinical trial purposes I have the right to receive available, easy to understand information about the genetic characteristics of my tumour should I wish to have that information. "

Also discussed in this session were the very stringent and challenging requirements of the UK Human Tissue Authority, the Human Tissue Act England 2004 and the Human Tissue Act Scotland 2006.

Following the tissue donation presentations, there was a 20 minute general discussion with the audience. The next day, the debate about tissue donation continued. 

The topic of resected brain tumour tissue donation for research constituted the main area of discussion in this early morning session, although post mortem brain tumour tissue donation also formed a part of this important debate.

It is anticipated that UK brain tumour patient groups will work alongside BNOS in addressing and trying to resolve some of the “tissue issues” which were talked about at the Glasgow conference.

Other presentations at the BNOS meeting included those on pre-clinical research and a strong neuropathology stream, the latter of which was hosted by the British Neuropathological Society at a special symposium, chaired by Willie Stewart (Glasgow, UK), on the first afternoon. (Dr Stewart also organised the BNOS conference.)

The three speakers, neuropathologists Bernd Scheithauer (Rochester, USA), Max Kros (Rotterdam, The Netherlands) and Andreas von Deimling (Heidelberg, Germany),  addressed a trio of crucial topics which included “Common pitfalls in surgical neuropathology” (Scheithauer), “Grading of gliomas: from eminence to evidence” (Kros) and “IDH1 analysis – impact on diagnosis and therapy of brain tumours” (von Deimling).

There were also a number of very interesting neurosurgical topics at Glasgow, for example, the use of 5-ALA fluorescence as a tool for achieving a more extensive resection.  The new IBTA magazine, “Brain Tumour”, features an article by Professor Walter Stummer (Munster, Germany) on this topic – free copies of this magazine can be ordered here:

 http://www.zoomerang.com/Survey/WEB22AJ3TMUBDV

Intraoperative ultrasound for use in better defining resectable areas of tumour was mentioned as well.  There is debate among the neurosurgical fraternity as to which approach is better and more cost-effective.

British neurosurgeon Colin Watts presented on “An evaluation of the tolerability and feasibility of combining 5-Amino-Levulinic Acid (5-ALA) with Carmustine Wafers (Gliadel)” and described a trial design for this combination.

A poster presentation (V Apostolopoulos, F Roncaroli and D Nandi, London, UK) on intraoperative, real-time 3D ultrasound looked at the benefits of that approach regarding extent of tumour resection.

In addition to the scientific sessions, there were also meetings at BNOS for ANON, the Association of Neuro-Oncology Nurses and SANON (Scottish Adult Neuro-Oncology Network).

There were some excellent studies at BNOS on depression and distress in brain tumour patients.

The psychological impact of a brain tumour on patients is substantial and the emerging studies connected to this topic are very important ones.

The joint teams from brain tumour units in Edinburgh and Glasgow (A Rooney, S McNamara, M Mackinnon, M Fraser, R Rampling, A Carson and R Grant) had three posters at BNOS on emotional distress and depressive symptoms in adults with primary glioma. An additional study on “Distress across the illness: a qualitative longitudinal study of people with malignant glioma and their relatives” was provided by D Cavers et al (Edinburgh).

“Red flags” for emotional distress - which according to Rooney et al affects one-third of newly diagnosed glioma patients and continues to persist after treatment – include “younger age, functional impairment and epilepsy.  Distressed patients may also be depressed.”

One of the highlights of the BNOS conference was an impressive oral presentation by Dr Sara Piccirillo, a young postdoctoral fellow based at Cambridge University and working with the British neurosurgeon Mr Colin Watts.

Dr Piccirillo won the 2010 British Neuro-Oncology Society Young Investigator Award (sponsored by Brain Tumour UK).  Her talk, entitled: “Stem cells and brain cancers: understanding the roots of oncogenesis”, discussed the implication of a range of observations “with particular focus on the biology of cancer stem cells isolated from human GBM as well as the identification of new therapeutic molecules, i.e. bmp proteins and cyclopamine”.

She gave her presentation with enormous poise, confidence, clarity and enthusiasm.  From the patient and caregiver perspective, it is tremendously exciting to see such dedication to the brain tumour field by up-and- coming researchers like Dr Piccirillo. 

It is reassuring to know that the torch which is so determinedly carried by the neuro-oncology professional community today is also being passed to a new generation of professionals who can take on these crucial roles and ensure a productive and promising future for brain tumour research. This gives brain tumour patients, their families and caregivers hope.

The conference ended with a wonderful presentation by Professor Roy Rampling, summarising advances in neuro surgery, neuro oncology and supportive care over the last three decades. 

He also spoke of IDH1 as being a very good marker for extended survival.  He mentioned the proposed study combining 5-ALA with Gliadel.  He talked in general about combinations of therapies achieving benefit rather than a single modality approach.

He also talked about vaccine therapies and in particular mentioned the forthcoming Phase I Immatics trial (IMA 950) for which he is study lead and which is a collaboration between Cancer Research UK, Cancer Research Technology and Immatics Biotechnologies.  This is for newly diagnosed GBM and he said he has a “high degree of optimism” for this therapy.  The vaccine will be given as an additional treatment to surgery, radiotherapy and chemotherapy. For further background information see: http://info.cancerresearchuk.org/news/archive/pressrelease/2010-02-16-vaccine-for-brain-cancer

Professor Rampling also mentioned the Cancer Genome Atlas and the important information about GBM which has emanated from that regarding four identified subtypes of this disease.

Professor Rampling punctuated his presentation with several forceful pleas to the audience of doctors, researchers and patient group representatives of “Don’t give up on brain tumour patients!”   He also showed a very interesting series of slides with comparative survival curves for brain tumour patients from early, pre-radiotherapy days to the present.  Overall, and with the development of new treatment approaches, the survival curves have risen significantly over the past decades, he said, which gives great hope. 

Despite formally retiring, we sincerely hope that Professor Rampling will continue to be involved in the brain tumour community in various ways in the future. 

We wish Roy Rampling all the very best and on behalf of the international brain tumour community, thank him warmly for his dedication and contributions to this field.

 
Kathy Oliver, 10th July 2010