Increased compliance with tumor treating fields therapy is prognostic for improved survival in the treatment of glioblastoma: a subgroup analysis of the EF-14 phase III trial This is probably the most important article about Optune. It updates the data reported the prior year and shows a little better results. If you can maintain over 90% compliance, the % of patients alive at 5 years was 29.3% compared to 4.5% in the control group which was Temodar and whatever else the doctor and patient wanted to use. This is the best survival rate ever reported in a large brain tumor trial and should finally put to rest any resistance to it's use. At this point, Optune (plus Temodar) should be considered the new standard of care.
New Liquid Biopsy Test Detects Brain Cancer, But It Doesn't Use Blood This is still experimental but very interesting. Hopefully you can get the same information as a biopsy in a much easier way. Very useful for inoperable tumors, or to see how a tumor is responding to treatment over time.
Early clinical trials of Toca 511 and Toca FC show a promising novel treatment for recurrent malignant glioma. This is another case where the median overall survival is meaningless and could hide impressive results. Toca 511 and TocaFC is an experimental gene therapy. Toca 511 is a virus that is injected one time. It infects only tumor cells (see https://tocagen.com/our-science/#platform_tech for information on how that magic happens. It is fascinating). When this virus infects a tumor cell, it inserts a gene that codes for a protein called CD. CD can break down the drug Toca FC into a chemotherapy drug 5FU, but only in cells that had the gene inserted. Toca FC is an oral drug which is a reformulation of an old drug approved for fungal infections. After injecting the virus, you wait a few weeks for the virus to spread to most of the tumor cells, then start a round of the oral TocaFC. This drug is harmless to the body except when it comes into contact with the CD protein, which converts the drug to 5FU which kills the nearby cells. This not only kills the tumor cells but exposes the insides of the tumor cells to the immune system to trigger an immune response. You then stop the TOCA FC for a few weeks to allow the virus to infect the remaining cells and repeat the process as long as is needed.
This article reports on the results. This is on 56 recurrent high grade glioma patients - which is medium sized - enough patients to see the trend. They used a comparison to historical controls. The Median overall survival only moved up 2.9 months compared to historical controls (that would be very significant if it was against randomized controls) and the response rate was only 11.3%. Just looking at those numbers, I would usually say it is interesting but needs more research before I would consider using it if I needed it. However, they then go on to say of those 11.3% responders, ALL had complete responses for an extended period of time. This is very impressive. It is rare to get a single complete response in a trial this size, and many times we see a complete response that only last a few months. Seeing about 6 patients our of 56 having a sustained complete response places this treatment among the best options for brain cancer patients.
Disclaimer: The Musella Foundation was an early supporter of this treatment via grants, and Tocagen is a sponsor of our organization
Alternating Electric Fields (TTFields) Activate Cav1.2 Channels in Human Glioblastoma Cells. This is a very technical article that says that adding a calcium channel blocker to TTFields (Optune) may work better than TTFields alone. There are many calcium channel blocking drugs available, approved as medications to treat high blood pressure. The authors used Benidine, which is approved in Asia but not the USA. They suggest, but did not try, Nifedipine may also work. This is available in the USA for high blood pressure and is easily available.
This is perfect for our Virtual Trial project. (See virtualtrials.com click on Virtual trial for details and to join). We can observe patients who are using Optune and compare those who also report using Nifedipine compared to those who do not report using Nifedipine. We do not have any patients reporting that combination yet - so we need more participants! All brain tumor patients should participate so when things like this come up we can just press a few keys on the keyboard and have the answer!
Effect of health disparities on overall survival of patients with glioblastoma. This article shows what we already knew: If you do not have insurance and you are diagnosed with a GBM, you are going to have trouble getting treatments and you will not have any chance to beat it. 80% of the uninsured patients did not even get the standard of care treatment. This is not acceptable. The system has to be changed.
