This is great news. Dr DeAngelis is one of the best neuro-oncologists and has now been named the chief medical officer of Memorial Sloan Kettering Cancer Center. Hopefully she will be able to encourage a focus on brain cancer at MSK!
Unfortunately the trial did not meet it's endpoint of median overall survival. I did not really expect it to as the immunotherapies appear to help only a small subset of patients, but when they do - it helps a lot. This leads to a long tail of survivors, but the median does not change. All of the immunotherapies by themselves will probably have this same problem. I think the key is to combine them to the point where most people benefit. I wouldn't write this off until we see the complete results and see if there is a signficant tail.
This is from our good friends at the National Brain Tumor Society, the Cancer Support Community and Gilda's Club. It is an introduction to brain tumors. Everyone should read it.
These are exciting results. I am proud to say the Musella Foundation is one of the sponsors of that program!
It is impressive that there is so much research going on with Optune right now, and in many types of cancer besides brain.
As I understand it, the failure was that the median progression free survival did not improve by adding Opdivo to the standard chemoradiation. This is not surprising as most of the immunotherapies seem to work really well on a small subset of the population. We see this in a long tail of survivors. However, even when there is an impressive improvement in long term survival in less than 50% of the patients, the median survival would not be expected to change much. This data has to be looked at closely to try to identify patients who were helped, and then try it in that subset of patient, perhaps in combination with other immunotherapies.
Although this is a small study and very early, the results are impressive. This is an experimental chemotherapy that works in such a way that the MGMT repair system doesn't matter. Temodar works best when MGMT is methylated (inactivated), and not so well when MGMT is unmethylated, so a huge unmet need is a new treatment that can help unmethylated MGMT GBM patients. I will be keeping an eye on this.
From our friends at Novocure. These open houses are fun and informative! Worth attending for anyone who has or knows someone with a gbm. Most are live but there are webinar versions in there for people not near a live site!
This is a very scary article. Most young adult patients did not continue to work after a high grade glioma diagnosis. I feel that this should be one of the endpoints in all clinical trials: is the patient able to work at the level they did before the diagnosis? In the past, unfortunately, most patients did not return to work after the diagnosis. Many who did were not able to work full time or in the same capacity as before. 2 years after diagnosis it was unheard of for patients to be working at a high level job.
So now as we are seeing more long term survivors with Optune and some experimental treatments, we now need to know their quality of life. Being able to work is a very important quality of life marker. I have come into contact with a few patients recently who are able to work at high pressure jobs, just like before their diagnosis, over 5 years since diagnosis. This was very rare before, so it is a significant finding for any trials.
This is early - only in animals so far - but would be a major step forward int he fight against brain tumors. We have some effective treatments that have to be delivered by convection enhanced delivery, such as Toca 511 and PVSRIPO. These experimental treatments showed some remarkable results after just one (or 2) course of treatment. With this new technology, we could use these therapies on an ongoing basis and perhaps drastically increase their effectiveness!
This shows that a small % of patients go on to become long term survivors using Avastin. The big trials for Avastin "failed" just like some of the immunotherapy trials "failed" because they look at the median patient to determine how well the treatments do. (Avastin showed an increase in the median progression free survival but not median overall survival). These treatments do not help the majority of patients, but they do help a minority of patients. The statistics we use does not recognize the importance of the tail of the long term survivors.
Even though each one alone only gives a small % of long term survivors, there is hope that the right combination of these could help the majority of patients become long term survivors.
I usually do not post personal stories like this but I need to clear up a huge misunderstanding of what Hospice is. Hospice is an amazing service that helps not only patients but also the caregivers near the end of the battle. It can be done in your home, or at a facility – whichever is easier for the patient and the family. I used them 3 times for Hospice at home and they were amazing each time. I can not imagine how much worse these deaths would have been without Hospice.
For the patient, they make sure they are comfortable. They take care of managing pain and other symptoms (like constipation), preventing bed sores and so much more. For the family, they provide guidance. NOBODY who has not gone through this knows how to handle the situation. The Hospice people are available by phone 24 hours a day for when questions or problems come up and they take so much of the pressure off of the family. They help guide the family through difficult decisions.
I can’t thank them enough.
This is only in mice right now but if you happen to have these 3 mutations, which signify a pretty much hopeless situation, it might be worth trying this combination of drugs.
I do not know how long it will remain open - so if you think you may need help with copayments for Temodar, Avastin and/or Optune, apply today!
This is the final report on the phase 2 trial of ICT-107 for newly diagnosed GBM. It was declared a "failure" because the median survival did not improve enough. However, digging into the details, there are many patients who responded very well, and there were no side effects. As with the other immunotherapy trials, this had a long survival tail which does not get reflected in the mean survival statistics. I still feel this is a worthy treatment to try.
I just heard (and reported in a recent news blast) that this vaccine is making a comeback - it was sold to a new company who hopefully will run another trial in the subgroups that benefitted!
Very important article. It points out how the tumor is usually made up of at least 2-4 different subtypes of GBM, and most importantly, that the cells are able to change from one type to another. This may account for how easily a tumor evades treatments. It also opens up a lot of possibilities such as targeting the mechanism that the cells use to change back and forth - perhaps have them all change to an easier cell to kill, Or just target the four subtypes with 4 different treatments and the cells would have no place to hide!
They report early results using a combination of 4 off label, easily available drugs for the treatment of GBM
The doctor mentioned, Dr Peereboom, is one of the best neuro-oncologists in the world, and one of my favorites. However, I disagree with what he says in the article. He talks about the average benefit is living 5 months longer with Optune than without. That is true but I look at it in a different way. I would probably not choose something that only adds 5 months to the average survival (if there were any other choices). I look at it as your chances of being alive in 5 years goes from about 4% without Optune, to 29% if you use Optune with at least a 90% compliance rate. That is definitely worth choosing.