Now that the 3 largest private health insurance carriers in the USA cover Optune, the rest should follow suit soon! This is a major victory in the fight against brain tumors. We thought the hard part was going to be getting FDA approval because it is a completely new type of treatment, but that actually was easy since the data supported it. Once that happened, I assumed patients would be able to just get it but the timing was terrible. Insurance companies have just started fighting back against expensive treatments and started denying all new treatments as a way of saving money until they are forced to pay for them. It was a long, hard battle but the people at Novocure persevered and won the battle with the private insurers.
Next up is Medicare. I had multiple meetings with Medicare and they are getting close to approving payment. The people I met with at Medicare understand that brain tumor patients need this treatment and they are trying to find a way to pay for it. Having the majority of private insurance companies paying for Optune, along with the recent publication of data in the Journal of the American Medical Association, should allow patients to appeal Medicare rejections successfully. IF you have a problem with a Medicare rejection, call me at 888-295-4740 and maybe I can write a letter for you to help with the appeal.
Valganciclovir and bevacizumab for recurrent glioblastoma: A single-institution experience. I love this type of project. These researchers tried adding the drug valganciclovir (Valcyte) to the treatment plan for recurrent gbm patients who were using Avastin. The concept behind this is that most or all GBMs have a virus in them called Cytomegalovirus. (Some researchers disagree and say NONE of the GBMs they tested have the virus). It is not known if the virus triggers the tumor to form, or if it makes the tumor more aggressive, or if it is just a bystander and doesn't affect the tumor. Valcyte is an oral antiviral drug which slows or stops the virus from reproducing. This study (although it is too small to be considered proof) shows that adding Valcyte increases overall survival and progression free survival. This implies that the CMV plays a role in making the tumor grow.
Using it in combination with Avastin was a great idea, since Avastin also slows down the tumor growth using a different pathway (VEGF). I think that hitting either pathway alone allows the tumor to find a way around the treatment, but hitting it on multiple pathways may be the answer. Perhaps adding 1 or 2 other treatments, hitting the tumor from another pathway, may make even a larger difference.
Photodynamic Therapy for Malignant Brain Tumors. Photodynamic therapy for malignant brain tumors involves giving the patient a dye right before surgery and then shining a laser light at the tumor at the time of surgery. It has been approved in Japan and this article shows that it may increase the time to progression, at least in the treated area, but a lot. There was no control group so we don't know for sure but compared to historic controls, it looks pretty good.
As far as I know, the clinical trials for photodynamic therapy of brain tumors in the USA are completed and we are waiting for the results.
Treatment with Tumor-Treating Fields Therapy and Pulse Dose Bevacizumab in Patients with Bevacizumab-Refractory Recurrent Glioblastoma: A Case Series. I do not think this was the best way to set up the study. The better way of doing it would have been to start Optune a few weeks after radiation is over, and perhaps try Avastin in a pulse dosing form - either as newly diagnosed at the same time you start the optune, or at the time of recurrence. Withholding Optune from a newly diagnosed patient for the purpose of entering a trial like this sounds unethical to me.
It shows a lack of understanding of how Optune works. It is a slow, gentle treatment. The time to start it is not when you have a recurrence as it needs a few months to kick in. The effect of slowing tumor growth starts immediately but it takes time before the tumor starts to shrink. The trial using it for newly diagnosed patients did much better than the one that started at recurrence.
Having said that, the results show that Optune does help when used this way, but I would like to see more trials using it the correct way. For those that missed out on the opportunity to use it when newly diagnosed, this shows that it is worth trying at the time of recurrence.
