Optune Open Houses are now availble as webinars! Due to the coronovirus, it probably isn't a great time to put a lot of people close together in a room, so Novocure's next few Open Houses will be online only!
Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis This article compares using intraoperative MRI to Gleolan (5-ALA) as to the abilty to maximize extent of resection, overall survival and progression free survival.
Intraoperative MRI is just what it sounds like - a machine that is able to do an MRI right in the operating room while you are having a surgery. It is important because when they use navigation systems they use the scans to see where they are on the brain. After they remove most of the tumor, the brain shifts a little, so the pre-op scan is no longer accurate. They can compensate for that by doing another scan while you are in surgery, and it also can see large areas of remaining tumor.
Gleolan is an fda approved dye, taken orally before surgery. During the surgery, when viewed under a special light, any remaining tumor glows and the surgeon can see what needs to be removed.
The study finds that both of these significantly improve survival and all of the other endpoints. It is not clear which one is better, with a hint that the intraoperative MRI is slightly better. I do not see why they can't use both and make it even better. Most hospitals do not have an intraoperative MRI. Any hospital can use Gleolan - a special attachment to an operating microscope is required but the cost is nothing compared to the cost of an MRI machine.
First-line Bevacizumab Contributes to Survival Improvement in Glioblastoma Patients Complementary to Temozolomide This is a controversial area. Some prior studies on GBM said there was an improvement in progression free survival with Bevacizumab (Avastin) but no improvement in overall survival. This study says there is an improvement with adding Avastin to the standard Temodar, and that benefit persists even if the MGMT is unmethylated. This opens another option for unmethylated MGMT patients. However, I would like to see more data as there are too many conflicting reports.
Tamoxifen Is a Candidate First-In-Class Inhibitor of Acid Ceramidase That Reduces Amitotic Division in Polyploid Giant Cancer cells-Unrecognized Players in Tumorigenesis Tamoxifen is an old drug approved for breast cancer. Many years ago, it was tried for glioblastoma. See https://virtualtrials.com/Tam1.cfm That was in the time before Temozolomide was available. Results were promising, but the results for Temozolomide were better so Tamoxifen lost favor.
This article shows a different way it may work, and it may have a role in the ultimate treatment cocktail. By itself, it is obviously not good enough but if this article is correct, it might help other treatments work.
One idea I had is that a possible escape mechanism for Optune is tumor cells getting larger. Tamoxifen might stop the giant cells from forming.
This is a perfect use of our virtual trial system - to track how these additional drugs can help the standard treatments. We need more people to participate. Virtualtrials.com/brain
I had a relative who was diagnosed with a GBM in 1992 and she did well with Tamoxifen for about 5 years, which was amazing back then.
