The following article, written by Sapna Parmar, a Clinical Oncology Pharmacist at Oncology Analytics, is the first of a four-part series on key trends and findings from the American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago May 31-June 4, 2019.
Brain tumors are abnormal growths of cells in the brain, which can cause a wide variety of symptoms, including seizures, sleepiness, confusion, and behavioral changes. Treatment for a brain tumor depends on the type, size, and location of the tumor, as well as the patient’s overall health and personal preferences. Regardless of these factors, better treatment options need to be available for patients to optimize outcomes.
Immunotherapy is a type of cancer treatment that boosts the body’s natural defenses to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function. To date, select immunotherapy agents such as pembrolizumab and nivolumab (PD-1 inhibitors), are only indicated in patients with brain metastases secondary to primary diseases such as lung cancer and melanoma. Therefore, there are no approved immunotherapy options for patients with brain tumors. However, there is increased use of immunotherapy being studied in this particular patient population.
There are many different types of brain tumors. Glioblastoma is the most common type of malignant brain tumor among adults – about 14,000 people in the U.S. are diagnosed with this very aggressive brain cancer every year. There is no early detection and no prevention. The prognosis for this cancer that can grow fast and spread quickly is grim: it will kill all but 15% within five years, and barely half of those diagnosed live 18 months. John McCain, a Vietnam War veteran and a six-term U.S. senator from the state of Arizona, suffered this disease. As her father fought his losing battle with glioblastoma, Meghan McCain asked her Twitter followers to support two nonprofits that fund research on this brain cancer. Research is the only hope for this deadly disease.
One of the most promising studies presented at the ASCO 2019 Annual Meeting was with avelumab, a PDL1 inhibitor. Avelumab was assessed in a phase 2 study for patients receiving standard therapy with newly diagnosed glioblastoma.
In the study presented at ASCO, 24 patients have started treatment. Out of the first eight patients analyzed at one year, 25% had a complete response, 12.5% a partial response, and 12.5% stable disease. The median progression-free survival (defined as the time from starting treatment until disease progression or death from any cause) was 11.9 months. These preliminary results suggest that the addition of avelumab to standard combination therapy early on is safe in patients with glioblastoma.