David Reardon, MD
Immunotherapy has shown promise for treatment of glioblastoma multiforme (GBM), the most common primary brain tumor in adults with historically poor prognosis, but experts agree that combination regimens have the greatest potential to achieve durable response. This is because GBM exhibits powerful adaptive capabilities, a relative lack of immunogenicity, an immunosuppressive tumor microenvironment, and intratumoral heterogeneity. “We’re not going to hit a home run with any treatment [on its own],” said David A. Reardon, MD, clinical director, Center for Neuro-Oncology, Dana-Farber Cancer Institute.
Because GBM is highly heterogeneous among individuals, careful selection of patients will be important for assessing treatment efficacy in clinical trials, Holland said. “I think things are getting better slowly, but really getting our hands around the biology of this and optimizing everything is about as good as we’re going to get until [there is a breakthrough],” said Holland.
Current Standard of Care
The current standard-of-care therapy is maximal surgical resection, followed by concomitant radiation therapy plus temozolomide for 6 weeks and then adjuvant temozolomide for 6 monthly cycles. This treatment strategy gained traction from a phase III trial, published in 2005, that reported median overall survival (OS) of 14.6 months.1
Results from a clinical trial showed that the addition of a tumor-treating fields device (Optune) to adjuvant temozolomide significantly improved median OS over temozolomide alone (20.5 vs 15.6 months; P
and led to approval of an expanded indication by the FDA for newly diagnosed GBM in 2015.3
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