Practice Update: Oncology

Updates in theManagement of GBM

Interview with Roger Stupp

by Jennifer N. Caudle

Dr. Caudle:

Several reports at ESMO pertain to immunotherapy and the management of

GBM. What can we infer about the potential role of immunotherapy in glioblastoma (GBM)

from this data?

Dr. Stupp:

So there is data on immunotherapy in GBM here at ESMO, but also at the prior

World Federation. Yes, there’s a great interest, but what we know is that probably with just

single modality checkpoint inhibition we’re not going to win. In recurrent disease, actually

the CheckMate study was negative, nivolumab versus bevacizumab there was no dif-

ference. Now what we saw here has been just feasibility studies leading to the ongoing

phase III studies with nivolumab in first-line both for MGMT methylated and unmethyl-

ated tumors, and here we’ll know probably during the course of next year a little more

whether this really has a benefit when you combine it with radiation in the upfront setting.

Dr. Caudle:

Okay. Lombardi et al. will be presenting data from a phase II study evaluating

regorafenib for the management of relapsed GBM. So how might this trial influence clin-

ical practice?

Dr. Stupp:

So, this is probably the most intriguing new data we have out at this ESMO.

Regorafenib tryosine kinase inhibitor had shown some activity, some long-term survival,

a one-year survival improvement in patients

with recurrent GBM. I think the data needs to

be confirmed. It’s a small phase II trial. It’s not

conclusive. The overall survival is overall very

short, shorter than you would have expected.

There maybe imbalances also in the number of

salvage treatments that has been offered, but

it’s intriguing enough to think of whether this

agent could have a role and we are in desper-

ate need of better treatments for patients once

they recur after first-line treatment.

Dr. Caudle:

Sure. Sure. That makes a lot of sense.

Van den Bent et al. report on different rates of

EGFR amplification in patients with GBM from

Asia compared to those from elsewhere in the

world. What might explain the discrepancy and

how could this change practice in the future?

Dr. Stupp:

So, it’s a very important analysis, and I

think it’s not fully understood why the distribu-

tion of EGFR amplification should be different in

the Asian population, which of course is also not

homogeneous and we don’t have all the details

there. It is important as we are targeting EGFR

with ongoing trials that are conducted with ABT-

414, so we have to understand who would be

the patients who would most likely benefit from

this approach. So, yes, this is important data

to further investigate and show you also the

challenges you have with molecular analysis.

Different assays may give different results and

so this needs to be further investigated.

Dr. Stupp is Professor of

Neurological Surgery, Neurology,

and Oncology, Northwestern

University Feinberg School of

Medicine; Co-Director,

Northwestern Brain Tumor

Institute; Associate Director for

Strategic Initiatives, Robert H.

Lurie Comprehensive Cancer

Center of Northwestern

University, Chicago Illinois.

www.practiceupdate.com/c/58003

NewData on

Anti-Emesis

Agents

Interview with Karin Jordan

by Jennifer N. Caudle

Dr. Caudle:

Let’s talk a little bit about

antiemesis agents. Ruhlmann et

al. are reporting a substudy of the

GAND-Emesis trial at ESMO this year.

What is the focus of the study and

what do the findings mean for patient

care?

Dr. Jordan:

Yeah, thanks for this ques-

tion. This study is very, very important

to the field of supportive care. For

the first time, Christina Ruhlmann, in

her oral presentation, will present us

with data on the no nausea rates and

especially if nausea has an impact on

the daily function of the life of patients

receiving radiochemotherapy. First of

all, the interesting point about this in

radiotherapy we are focusing for a

long period of time, meaning from

day one when the radiochemother-

apy starts until 35 days after the

treatment ends. So, the patient will

focus on a long period of time.

So the question is what does this

study show to us, to the community,

and actually with the triple regimen

antiemetics consisting of fosaprepi-

tant, a steroid, and a 5-HT3 receptor

antagonist, she was able to show a

reduced impact of functional daily life.

So, this means we need an optimal

antiemetic prophylaxis first to reduce

the symptoms, and this also has a

really high impact on the health-re-

lated quality of time, and again, this

is really important, especially when

you consider such a long period of

time. So, this study as well will have

a great impact and this study will be

practice changing and will give a new

recommendation.

Dr Karin Jordan is

Associate Professor of

Medical Oncology and

Supportive Care in the

Department of

Oncology/

Haematology at the

University Hospital,

Halle.

www.practiceupdate.com/c/58007

It’s intriguing enough to

think of whether this agent

could have a role and we

are in desperate need of

better treatments for

patients once they recur

after first-line treatment.

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