Practice Update: Oncology

CONFERENCE COVERAGE 16

Updates in theManagement of GBM Interview with Roger Stupp MD by Jennifer N. Caudle DO 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,

NewData on Anti-Emesis Agents Interview with Karin Jordan MD by Jennifer N. Caudle DO 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.

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.

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.

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.

Dr Karin Jordan is Associate Professor of Medical Oncology and Supportive Care in the Department of Oncology/ Haematology at the University Hospital, Halle.

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