Interesting treatment information published in Oncology on 8...

Interesting treatment information published in Oncology on 8 February 2024, about Prof Richard Scolyer regarding his personalized vaccine immunotherapy for glioblastoma (GBM).

My dear colleague, Prof. Richard Scolyer, MBBS, MD, FRCPA, FRCPath, FAHMS, AO, was diagnosed with GBM in May 2023. Rather than undergoing the classical treatment paradigm of debulking surgery followed by radiotherapy and temozolomide according to the EORTC 22981/26981 study by Stupp et al2 and waiting for the inevitable recurrence, he decided to try a different treatment approach.

His therapy consisted of an open biopsy to obtain untreated tissue to allow the development of a personalized vaccine, followed by neoadjuvant triplet immunotherapy with anti–CTLA-4, anti–PD-1, and anti–LAG-3. Subsequently, he has undergone debulking surgery and adjuvant radiotherapy and is currently receiving adjuvant immunotherapy plus a personalized vaccine. He recently had a follow-up scan and is now 8 months progression-free.

Moreover, translational studies have shown, among other things, that neoadjuvant immunotherapy has led to an influx in T cells and upregulation of PD-L1, and even anti–PD-1 could be found bound to the tumor that was resected after the single dose of neoadjuvant triplet immunotherapy.

Of course, N = 1 studies do not deliver the evidence to be able to change practice definitively; but, they can be considered hypothesis-generating to test feasibility and find a potential signal in terms of efficacy. Importantly, Prof. Scolyer has not undergone immunotherapy after radiotherapy and chemotherapy, especially, has neither depleted his host immune system nor deteriorated his performance score. This means that we might need to test immunotherapy at a different stage in GBM — as a first-line treatment and not after having failed the current standard-of-care approach by Stupp et al or when the disease has destroyed the host to an extent that nearly nothing will show efficacy anymore.

Therefore, despite this negative trial on CAR T-cells for GBM, we must be careful not to throw away the baby with the bathwater. And we might need to reset our existing dogmata to do so.

Prof. Scolyer and his long-term friend, co-medical director of the Melanoma Institute Australia and oncologist Prof Georgina Long, have been very vocal about this journey and have used the lessons they learned in melanoma to attempt to break the cycle in GBM.3 Of course, it is early days; but, the enormous track record they have in melanoma, as well as this latest work in GBM recently, has seen them being awarded the prestigious title of Australian of the Year.

https://www.practiceupdate.com/c/161272/1/1/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=NDQ3MTgxOTYwMzc4S0&lid=20844130

Regards.