No abstract

Treatment with small-molecule inhibitors, guided by precision medicine has improved patient outcomes in multiple cancer types. However, these compounds are often not effective against central nervous system (CNS) tumors. The failure of precision medicine approaches for CNS tumors is frequently attributed to the inability of these compounds to cross the blood-brain barrier (BBB), which impedes intratumoral target engagement. This is complicated by the fact that information on CNS penetration in CNS-tumor patients is still very limited. Herein, we evaluated cerebrospinal fluid (CSF) drug penetration, a well-established surrogate for CNS-penetration, in pediatric brain tumor patients. We analyzed 7 different oral anti-cancer drugs and their metabolites by high performance liquid chromatography mass spectrometry (HPLC-MS) in 42 CSF samples obtained via Ommaya reservoirs of 9 different patients. Moreover, we related the resulting data to commonly applied predictors of BBB-penetration including ABCB1 substrate-character, physicochemical properties and in silico algorithms. First, the measured CSF drug concentrations depicted good intra- and interpatient precision. Interestingly, ribociclib, vorinostat and imatinib showed high (> 10 nM), regorafenib and dasatinib moderate (1–10 nM) penetrance. In contrast, panobinostat und nintedanib were not detected. In addition, we identified active metabolites of imatinib and ribociclib. Comparison to well-established BBB-penetrance predictors confirmed low molecular weight, high proportion of free-drug and low ABCB1-mediated efflux as central factors. However, evaluation of diverse in silico algorithms showed poor correlation within our dataset. In summary, our study proves the feasibility of measuring CSF concentration via Ommaya reservoirs thus setting the ground for utilization of this method in future clinical trials. Moreover, we demonstrate CNS presence of certain small-molecule inhibitors and even active metabolites in CSF of CNS-tumor patients and provide a potential guidance for physicochemical and biological factors favoring CNS-penetration.

Targeting oncogenic fusion-genes in pediatric high-grade gliomas (pHGG) with entrectinib has emerged as a highly promising therapeutic approach. Despite ongoing clinical studies, to date, no reports on the treatment of cerebrospinal fluid (CSF) disseminated fusion-positive pHGG exist. Moreover, clinically important information of combination with other treatment modalities such as intrathecal therapy, radiotherapy and other targeted agents is missing. We report on our clinical experience of entrectinib therapy in two CSF disseminated ROS1/NTRK-fusion-positive pHGG cases. Combination of entrectinib with radiotherapy or intrathecal chemotherapy appears to be safe and has the potential to act synergistically with entrectinib treatment. In addition, we demonstrate CSF penetrance of entrectinib for the first time in patient samples suggesting target engagement even upon CSF dissemination. Moreover, in vitro analyses of two novel cell models derived from one case with NTRK-fusion revealed that combination therapy with either a MEK (trametinib) or a CDK4/6 (abemaciclib) inhibitor synergistically enhances entrectinib anticancer effects. In summary, our comprehensive study, including clinical experience, CSF penetrance and in vitro data on entrectinib therapy of NTRK/ROS1-fusion-positive pHGG, provides essential clinical and preclinical insights into the multimodal treatment of these highly aggressive tumors. Our data suggest that combined inhibition of NTRK/ROS1 and other therapeutic vulnerabilities enhances the antitumor effect, which should be followed-up in further preclinical and clinical studies.

Evaluating the ability of a drug to permeate the blood-brain barrier is not a trivial task due to the structural complexity of the central nervous system. Nevertheless, it is of immense importance to identify related properties of the drugs either to be able to produce a desired effect in the brain or to avoid unwanted side effects there. In the past, multiple methods have been used for that purpose. However, these are sometimes methodologically problematic and do not claim universal validity. Therefore, additional new methods for judging blood-brain barrier penetration by drugs are advantageous. Accordingly, within the scope of this study, we tried to introduce a new structure-derived parameter to predict the blood-brain barrier permeation of small molecules based on ion mobility mass spectrometry experiments – the collision cross section, as an illustration of the branching and the molecular volume of a molecule. In detail, we used ion mobility quadrupole time-of-flight mass spectrometric data of 46 pharmacologically active small-molecules as well as literature-derived permeability and lipophilicity data to set up our model. For the first time we were able to show a strong correlation between the brain penetration of pharmacologically active ingredients and their mass spectrometric collision cross sections.

An oligostyrene-like product (F2L5250) was reported to have estrogen-like activity (statistically significant increases in means for absolute uterine weight and the ratios of the uterine weight to terminal body weight) in juvenile female rats provided a dietary concentration of 100 ppm F2L5250 for four consecutive days. The highest no-effect-level (NOEL) for estrogenic activity was 80 ppm in the diet, corresponding to a daily intake of 13.3 mg F2L5250/kg. Although it is unlikely that such estrogenic tetramers would occur in commercial polystyrene, the Styrene Steering Committee (SSC) of the European Chemical Industry Council (CEFIC) sponsored the current extensive project to address any concern that human consumption of styrene oligomers migrating from polystyrene containers into food, e.g., from packaged yoghurt, or from the use of EPS coffee cups and related products, might affect human health. To ensure confidentiality and compliance with the highest scientific and regulatory standards, the entire project was conducted without knowledge of the oligomer migrates tested, and all activities were managed and audited under a contract between the SSC and a third party, Argus International. This paper describes the preparation and analyses of the 23 representative polystyrenes [9 general purpose polystyrenes (GPPS), 8 high impact polystyrenes (HIPS) and 6 expandable polystyrenes (EPS)] evaluated for estrogenicity in an in vivo uterotrophic assay in immature female rats. The polystyrene samples were chosen to represent food packaging applications. They were obtained from participating European Polystyrene Manufacturers, coded at the TNO Nutrition and Food Research Institute, Utrecht, The Netherlands (TNO) and sent to BASF, Ludwigshafen, Germany for preparation of test bars (GPPS and HIPS) or test foam parts (EPS). The prepared polystyrene test bars or test foam parts were submitted to elution with 50% aqueous (v/v) ethanol for 10 days at 40 degrees C, a procedure which simulates an exposure at ambient temperature for several weeks and represents an exaggeration in comparison with yogurt, for which directive 85/572/EEC1 defines 3% aqueous acetic acid as the official food simulant. To further exaggerate the potential concentration of the possible migrates, the surface/volume ratio selected for elution was the maximum experimentally possible, i.e., approximately 56 dm2/kg food for the GPPS and HIPS bars and approximately 38 dm2/kg food for the EPS foam, representing a multiple of approximately 9 (GPPS and HIPS) and 6 (EPS), times the conventional surface/volume ratio of 6 dm2/kg. These obtained styrene oligomer migrates were then diluted to 25% aqueous (v/v) ethanol, a concentration that could be tolerated by the test animals. After dilution, the low and high concentrations represented multiples of 0.5 and 4.6 (GPPS and HIPS) and 0.5 and 3.2 (EPS) the conventional surface/volume ratio, respectively. These levels simulated daily human consumption of 500 or 5,000 g of food for the GPPS and HIPS samples and of 500 or 3,150 ...