Research News for the Fifth Two Months of 2021

This is the eleventh article of the project which aims to collect periodically (every two months) the news of research on possible treatments for glioblastoma multiforme.
Below is the news that we considered most significant. As for the previous articles in the series, each news will be preceded by the original title with a link to the source and followed by a short comment. The criterion with which the news is chosen is always to include in general only the news related to research in the clinical phase, unless the research potential for the treatment of glioblastoma is not really considerable.

Presentazione del volume “I Numeri del Cancro in Italia 2021” 
The volume “I numeri del cancro in Italia 2021” was presented last week. In the section dedicated to tumors of the central nervous system (CNS) edited by the Oncological Institute Veneto-IRCCS of Padua we read that among the risk factors there are exposure to gamma and X radiation while for exposure to electromagnetic fields (including those resulting from the use of cell phones) limited evidence is recognized. Some genetic syndromes are associated with a higher risk and a higher familial risk not associated with known genetic syndromes has been observed. While in the USA and England there has been a steady increase in incidence in recent years, in Italy it seems that the incidence is constant. Malignant tumors are more common in men than in women. The possibility of an “early diagnosis” does not yet exist. Most CNS cancers are diagnosed following the appearance of symptoms. Regarding primary prevention, a partly unresolved question is the role of cell phones and in the doubt and waiting for confirmatory studies, the American Cancer Society suggests, to limit their use, especially by children, and to use earphones. The most frequent malignant tumor of the CNS is glioblastoma, with an estimated incidence rate of 3-4 cases for 100,000 inhabitants in a year. The average age of onset of glioblastoma is around 65 years with an incidence at this age of about 10-12 cases for 100,000 inhabitants in a year. Median survival is approximately 15 months with a survival rate of less than 5% at 5 years after diagnosis. Standard therapy consists of surgical resection followed by radiotherapy and chemotherapy with temozolomide (Stupp protocol). At the time of recurrence, there is no standard treatment and it is advisable to include the patient in experimental clinical trials. However, a recent Italian phase 2, multicentre, randomized study (REGOMA) published on Lancet Oncology in 2019 demonstrated greater efficacy of the drug regorafenib compared to treatment with nitrosourea. The first results on “targeted therapy” (molecular target therapy) appear promising but due to the rarity of the tumor pathology and specific genetic mutations, it is essential, whenever possible, to include patients in experimental protocols in reference specialised neuro-oncological centers.

Lessons learned from contemporary glioblastoma randomized clinical trials through systematic review and network meta-analysis: part 2 newly diagnosed disease 
This is a meta-analysis of major Phase 3 clinical trials for new diagnoses of glioblastoma. The Optune device had the best ever results of any trial for glioblastoma. The sad thing is that other treatments that have achieved excellent results while not achieving the objectives set by the trial have also been abandoned and are not being developed further. One of these treatments is ICT-107, a therapeutic vaccine that has worked extraordinarily well in some people and in general has worked much better than the Stupp protocol while not achieving the objectives set by the experiment.

Does proton therapy have a role in the treatment of brain tumors?  
Proton therapy has advantages over photon-based or gamma-ray radiation therapy. It limits the dose that ends up on healthy tissue and in the case of tumors close to the optic nerve it can affect the tumor without damaging the optic nerve. The downside is that since malignant tumors are widespread, it is necessary to treat a larger area that goes beyond the area of the tumor visible through an MRI. These centers are rarer, more expensive and therefore difficult to find and further studies are needed to decree a real advantage.

Repeated superselective intraarterial bevacizumab after blood brain barrier disruption for newly diagnosed glioblastoma: a phase I/II clinical trial  
This is a new way of administering Avastin. In practice, the arteries feeding the tumor site are examined and mapped and the drug is injected through catheters directly into the specific arteries. The technical risk associated with the procedure is offset by the fact that the drug does not end up in the rest of the body. The results compared with the historical results obtained by the drug report a PFS of 11.5 months and an OS of 23.1 months. The method can of course also be used for other drugs. It would be nice to see it applied to a cocktail of drugs chosen on the basis of the molecular analysis report performed on the glioblastoma sample taken during surgery.

Efficacy and Safety of Tumor Treating Fields (TTFields) in Elderly Patients with Newly Diagnosed Glioblastoma: Subgroup Analysis of the Phase 3 EF-14 Clinical Trial  
This article demonstrates the great benefits of the Optune device on people aged 65 and over. If Optune is combined with Temozolomide and used for at least 75% of the time, the median survival is 21.7 months. At 5 years, survival was 0% in the control group and 15% in the Optune device group.

That’s all for this two-month period. I ask you to continue to help the fundraising campaign for CUSP9v3 Phase II-III for Emanuele by sharing the link in order to spread the word and raise awareness as many people as possible. Now, after the release of the remarkable results of the CUSPv3 Phase I trial, we are closer to the goal. On the Contributions page of the site you can find other ways to make donations.
Contribute you too to finance this clinical trial!

Best of luck to all those fighting glioblastoma and their loved ones!