Practice Update | Onology

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the randomized phase 3 study of nivolumab
versus bevacizumab in recurrent glioblas-
toma. That was presented at the World
Federation of Neuro-Oncology Societies
just a few months ago, and unfortunately
that trial was negative. There was no differ-
ence in outcome between nivolumab and
bevacizumab in recurrent glioblastoma. But
what they did in this trial was they looked at
those patients who appear to be progress-
ing and had surgery to see if they could
look at the pathology to differentiate those
patients who are truly progressing and
those patients who may have what’s called
pseudo-progression or an inflammatory
response. They actually didn’t see a lot of
inflammation in these tumors and the patho-
logic analysis did not really predict outcome.
So that’s an area that we still need to do a
lot of work on separating pseudo-progres-
sion from true tumor progression.
Dr Caudle: You mentioned briefly the con-
cept of timing, especially for immune
therapies, and I want to talk a little bit about
that. When during therapy do you think is
the optimal timing for the integration of
immune therapies, particularly given the
immune suppression inherent in standard
adjuvant therapy?
Dr Wen: I think initially a lot of the trials were
done in recurrent disease so this follows
radiation therapy and temozolomide, both
of which can produce a fairly profound lym-
phopenia. And then the tumors are often
bulky when patients are on steroids. So in
that setting, trying to stimulate the immune
system is probably a real challenge.
I think many of the newer studies are in
first-line setting in patients who’ve had a
gross total resection. There isn’t a lot of
residual disease that can produce immu-
nosuppressive factors and where the
patient’s immune system is more robust
because they’ve just started their treat-
ment with radiation or temozolomide. And
in some of these patients and those who
are MGMT-unmethylated, which temozolo-
mide is not particularly useful, there’s been
a trend to drop the temozolomide so these
patients would get just the radiation and
whatever immunotherapeutic agent is being
planned with the hopes that by avoiding the
temozolomide, the immune suppression will
be avoided also. Those studies are ongoing.
Dr Caudle: Let’s switch gears just a little bit.
Can you elaborate on the recent study that
was evaluating the use of a personalized
peptide vaccine in patients with refractory
GBMs and how this new class of agents can
potentially move up to the upfront setting?
Dr Wen: Yes. So they used peptide vaccines
and tried to match it to the patient’s geno-
type. In fact, there are a number of these
studies now ongoing in the first-line set-
ting both in Europe and then in the US. At
Dana-Farber, my colleague David Reardon
is running one of these trials for the vaccine
called NeoVax where patients get whole-ex-
ome sequencing and then, depending on
the mutations, a personalized vaccine is
made for that patient. It’s administered to
the patient after radiation and temozolomide
with the plan to add a PD-1 antibody to that
regimen. I think that these approaches are
really exciting and there’s more and more
of these being developed.
Jennifer Caudle DO is
Assistant Professor at Rowan
University School of
Osteopathic Medicine in
New Jersey.
Watch the full interview on
FROM 1ST FEBRUARY 2017
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Myelodysplastic syndrome/Acute Myeloid Leukaemia ( MDS/AML ) have been reported in a small number of patients (<1%) and the majority of reports have been fatal.Pneumonitis has been reported
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increased creatinine; Common (≥1% to <10% ): stomatitis, upper abdominal pain, thromboyctopenia; for other listed adverse reactions, see full PI. DOSAGE AND ADMINISTRATION: 400 mg (eight
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inclusion in the ARTG: 7th January 2016. References 1. Lynparza Approved Product Information 10 October 2016. 2. PBS Website
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there may be implications for other family members. Appropriate genetic
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component, and who has responded to subsequent platinum-based chemotherapy, requested by a specialist or
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