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Continuum Postreading Test 29(6) December 2023 (Neuro-oncology)

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Neuro-oncology issue, participants will be able to:

Recognize the evolving trends in molecular neuropathology and understand how they have become integral to modern tumor classification

Describe clinical presentations, diagnosis, and management of patients with gliomas

Describe the clinical presentation, diagnosis, biology, management, and prognosis of the most common pediatric brain tumors and neurocutaneous syndromes

Understand the signs, symptoms, approach to diagnosis and staging, and treatment options for newly diagnosed, relapsed, and refractory primary and secondary central nervous system lymphoma

Describe the presentation, diagnosis, treatment, and management of patients with central nervous system metastases, specifically brain parenchymal and leptomeningeal metastases

Describe the presenting features, imaging characteristics, pathology, and management of tumors arising in or along the base of the skull

Describe the initial evaluation to recognize, diagnose, and treat paraneoplastic neurologic disorders to achieve optimal oncologic and neurologic outcomes

Identify the presenting signs and symptoms, pathophysiology, and management of the most common peripheral and central neurologic complications of chemotherapy, radiation therapy, and antiangiogenic therapy used for cancer treatment

Describe common complications from cancer immunotherapy, including immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, as well as their workup and management

Describe the spectrum of complications experienced by patients with central nervous system malignancies including vasogenic edema, tumor-related epilepsy, venous thromboembolism, and endocrine and infectious disorders, and the best practices to minimize associated morbidity and mortality

Summarize principles of palliative care for patients with central nervous system tumors including symptom management, support, and distress alleviation for care partners, transparent and empathetic communication, and timely and meaningful advance care planning

Core Competencies

This Continuum: Lifelong Learning in Neurology Neuro-oncology issue covers the following core competencies:

Patient Care and Procedural Skills
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice

More Info

Contributors^a

Lakshmi Nayak, MD,
Guest Editor
Director, Center for CNS Lymphoma; Associate Professor of Neurology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Nayak has received personal compensation in the range of $500 to $4999 for serving as a consultant for Genmab, Gilead Sciences, Inc., and Ono Pharmaceutical Co., Ltd. and for serving on a speakers bureau for Ono Pharmaceutical Co., Ltd. An immediate family member of Dr Nayak has received personal compensation in the range of $500 to $4999 for serving as a consultant for Brave Bio. Dr Nayak has received publishing royalties from a publication relating to health care.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Nayak reports no disclosure.

Macarena I. de la Fuente, MD
Neuro-oncology Division Chief, Associate Professor, and Program Director, Neuro-oncology Fellowship, Department of Neurology, University of Miami; Clinical Research Chair, Neuro-oncology Site Disease Group, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida

Relationship Disclosure: Dr de la Fuente has received personal compensation in the range of $500 to $4999 for serving as a consultant for Les Laboratoires Servier and Pyramid Biosciences, Inc. An immediate family member of Dr de la Fuente has received personal compensation in the range of $500 to $4999 for serving as a consultant for ADC Therapeutics SA and Genentech, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr de la Fuente discusses the unlabeled/investigational use of vorasidenib in clinical trials for the treatment of brain tumors.

Deborah A. Forst, MD
Assistant Professor of Neurology, Harvard Medical School; Neuro-oncology Faculty Member, Massachusetts General Hospital Cancer Center, Boston, Massachusetts

Relationship Disclosure: Dr Forst has stock in Lilly and has received research support from Conquer Cancer, the ASCO Foundation, the Palliative Care Research Cooperative Group, and the American Cancer Society Institutional Research Grants.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Forst discusses the unlabeled/investigational use of bevacizumab for the treatment of vestibular schwannomas in the setting of NF2-related schwannomatosis and nivolumab and ipilimumab for the treatment of aggressive adenomas.

Jerome J. Graber, MD, MPH, FAAN
Associate Professor of Neurology and Neurosurgery; Neuro-oncology Fellowship Director, University of Washington, Seattle, Washington

Relationship Disclosure: Dr Graber has noncompensated relationships as a member of the board of directors of the American Society of Neuroimaging, a certification exam committee member with the United Council of Neurological Subspecialties, an editorial board member for Journal of Pain and Symptom Management, Neuro-Oncology: Practice, and Practical Neurology, and a member of the Neurology Question of the Day committee with the American Academy of Neurology (AAN) that are relevant to AAN interests or activities.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Graber discusses the unlabeled/investigational use of corticosteroids, cyclophosphamide, intravenous immunoglobulin, ixazomib, lenalidomide, plasma exchange, and rituximab for the treatment of paraneoplastic neurologic syndromes.

Pamela S. Jones, MD, MS, MPH
Assistant Professor, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Jones reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jones discusses the unlabeled/investigational use of bevacizumab for the treatment of vestibular schwannomas in the setting of NF2-related schwannomatosis and nivolumab and ipilimumab for the treatment of aggressive adenomas.

Priya Kumthekar, MD
Associate Professor of Neurology and Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Relationship Disclosure: Dr Kumthekar has received personal compensation in the range of $500 to $4999 for serving as a consultant for Janssen, Orbus Therapeutics, and Roche; in the range of $5000 to $9999 for serving as a consultant for Affinia Therapeutics, BioClinica, Inc., BPGbio, Inc., EnClear therapies, and Servier Laboratories and for serving on a speakers bureau for Seagen, Inc.; and in the range of $10,000 to $49,999 for serving as a consultant for Biocept, Inc., BioClinica, Inc., and Novocure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kumthekar discusses the unlabeled/investigational use of ANG1005, cytarabine, ipilimumab, methotrexate, nivolumab, pemetrexed, pertuzumab, thiotepa, topotecan, and trastuzumab for the treatment of brain metastases and leptomeningeal disease.

Emilie Le Rhun, MD
Senior Physician, University Hospital of Zürich, Zürich, Switzerland

Relationship Disclosure: Dr Le Rhun has received personal compensation in the range of $500 to $4999 for serving as a consultant for Les Laboratoires Servier and Pierre Fabre and on a scientific advisory or data safety monitoring board for Astra Zeneca, Bayer AG, F. Hoffmann-La Roche Ltd., Janssen, Leo Pharma A/S, Les Laboratoires Servier, and Seagen, Inc. An immediate family member of Dr Le Rhun has received personal compensation in the range of $500 to $4999 for serving as a consultant for Les Laboratoires Servier, Medac GmbH, NeuroSense Therapeutics, Novartis AG, and Novocure GmbH and on a scientific advisory or data safety monitoring board for CureVac SE, Orbus Therapeutics, Inc., and Philogen S.p.A. The institution of Dr Le Rhun has received research support from Bristol-Myers Squibb. The institution of an immediate family member of Dr Le Rhun has received research support from Quercis Pharma and Versameb AG.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Le Rhun discusses the unlabeled/investigational use of ANG1005, cytarabine, ipilimumab, methotrexate, nivolumab, pemetrexed, pertuzumab, thiotepa, topotecan, and trastuzumab for the treatment of brain metastases and leptomeningeal disease.

Fatema Malbari, MD
Associate Professor and Director of Neuro-oncology, Division of Pediatric Neurology and Developmental Neurosciences; Associate Program Director, Child Neurology Residency Program, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

Relationship Disclosure: Dr Malbari reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Malbari reports no disclosure.

David M. Meredith, MD, PhD
Associate Pathologist, Brigham and Women’s Hospital, Boston, Massachusetts; Assistant Professor, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Meredith reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Meredith reports no disclosure.

David J. Pisapia, MD
Associate Professor of Pathology and Laboratory Medicine, Weill Cornell Medical Center, Cornell University, New York, New York

Relationship Disclosure: Dr Pisapia owns stock in Tesla. The institution of an immediate family member of Dr Pisapia has received research support from the National Institutes of Health (NIH). The institution of Dr Pisapia has received research support from the Rhodes Center for Glioblastoma.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Pisapia reports no disclosure.

Lauren Schaff, MD
Assistant Member, Memorial Sloan Kettering Cancer Center, New York, New York; Assistant Professor, Weill Cornell Medical Center, Cornell University, New York, New York

Relationship Disclosure: Dr Schaff has received personal compensation in the range of $500 to $4999 for serving as a consultant for Guidepoint and Ono Pharmaceutical Co., Ltd., and in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for BTG International, Inc. An immediate family member of Dr Schaff has received personal compensation in the range of $500 $4999 for serving as an expert witness for MichieHamlett Attorneys at Law. Dr Schaff has received research support from BTG International, Inc. and Merck & Co., Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Schaff discusses the unlabeled/investigational use of chimeric antigen receptor T-cell therapy, ibrutinib, immune checkpoint inhibitors, lenalidomide, and temozolomide for the treatment of primary central nervous system lymphoma.

Akanksha Sharma, MD
Assistant Professor, Pacific Neuroscience Institute/Saint John’s Cancer Institute, Santa Monica, California

Relationship Disclosure: Dr Sharma has received personal compensation in the range of $0 to $499 for serving as a speaker with Project Ronin, and in the range of $500 to $4999 for serving as an advisory board member with the National Brain Tumor Society and on a scientific or data safety monitoring board for Novocure. Dr Sharma has a noncompensated relationship as an advisory board member with ElevateMeD, Inc. that is relevant to American Academy of Neurology (AAN) interests or activities. The institution of Dr Sharma has received research support from Apollomics, Inc., Chimerix, Inc., Incyte, and Novocure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Sharma reports no disclosure.

Jennie W. Taylor, MD, MPH
Associate Professor of Neurology and Neurological Surgery, University of California, San Francisco, San Francisco, California

Relationship Disclosure: Dr Taylor has received research support from Mount Sinai University and the University of Colorado. Dr Taylor has received publishing royalties from a publication relating to health care. The institution of Dr Taylor has received research support from AbbVie, Inc., Agios Pharmaceutical, Inc., Bristol-Myers Squibb, and Navio Theragnostics, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Taylor reports no disclosure.

Nancy Wang, MD, MPH
Neuro-oncologist, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Boston, Massachusetts; Instructor in Neurology, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Wang has received personal compensation in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for Seagen, Inc. The institution of Dr Wang has received research support from Merck & Co., Inc. Dr Wang has received publishing royalties from a publication relating to health care.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wang discusses the unlabeled/investigational use of anakinra, antithymocyte globulin, and siltuximab for the treatment of immune effector cell–associated neurotoxicity syndrome.

Mary R. Welch, MD, MS
Associate Professor of Neurology, Columbia University Irving Medical Center, New York, New York

Relationship Disclosure: Dr Welch reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Welch reports no disclosure.

Self-Assessment and CME Test Writers

Adam Kelly, MD, FAAN
Associate Professor, Department of Neurology, Stroke Division; Associate Professor, Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York

Relationship Disclosure: Dr Kelly has received personal compensation in the range of $500 to $4999 for serving as a consultant for Grand Rounds, as an editor, associate editor, or editorial advisory board member for the American Academy of Neurology (AAN), and as a question writer for various educational offerings with the AAN.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kelly reports no disclosure.

Allyson R. Zazulia, MD
Professor of Neurology and Radiology and Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri

Relationship Disclosure: Dr Zazulia reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.

^AAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.