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  • SNO Update

    Hi. Just got back from SNO (Society of Neuro-oncology annual meeting). Excellent meeting - overwheling with the amount of information presented. I am going to mention a few of the highlights and welcome others who went to the meeting to post their thoughts.

  • #2
    DCVAX: No updated data was presented but we had a nice meeting with all of the advocacy groups and Northwest bio. They went over the unblinded data that they presented last time and said they will present the final results "soon". I pressed them on that and they said they know but can't tell me. I get the feeling it is going to be pretty good. The longer they wait the better the data will look and it has been a long time.

    Comment


    • musella
      musella commented
      Editing a comment
      This requires tumor tissue - either fresh or frozen in a special way. So if you are having a surgery it might be worthwhile to have the tumor frozen in the correct way so you can get this IF dcvax is approved.. for details on freezing, see: http://virtualtrials.com/pdf2018/dcvaxfreeze.pdf or a company that does it for you is storemytumor.com

    • Elvisdk
      Elvisdk commented
      Editing a comment
      Dear Dr. Albert Musella

      Dear Dr. Musella. You attended the Patient Advocacy Meeting that Northwest Bio hosted at the SNO Conference on November 23rd.
      And I have some questions regarding your point of view and experience with NWBOs DCVax-L fase 3.
      1: Who did you talk to at the NWBO meeting?
      2: What was your feeling about the time perspective on SAP, data lock and regarding unblinding?
      3: With your broad and nuanced experience with GMB, what does your intuition say about PFS as a success criteria?
      Thank you in avance.
      Per Nielsen Denmark😊

  • #3
    Tocagen: The results from the trial were presented and it did not hit the main endpoint of overall survival in the intent to treat group. A few pre specified subgroups did show impressive results. There was a lot of discussion on reasons why. One possibility is that the trial stopped the oral 5FU part at the first sign of progression. 50% of the patients in the treatment group showed signs of progression at the first scan and were stopped. The average number of cycles of the drug was 2. Looking back, that was probably a terrible idea because with any immunotherapy, there is more swelling on patients who are responding to the therapy best - which appears as progression on scan.. so they stopped the trial early for those most likely to respond.
    If you do not include the 1/2 of patients who had to stop at that first scan, the results were much better. However, most likely they have to do another trial to prove it works. They are planning another trial for newly diagnosed gbm, and in the control group they will allow patients to use Optune... so I support the new trial design. All get surgery, radiation and temodar, and are randomized to get tocagen or optune.
    If anyone doesn't know what Tocagen is, ask and I will explain

    Comment


    • adzz
      adzz commented
      Editing a comment
      First of all thank you for sharing all the updates.
      There is a presentation about the failed trial available on Tocagen website:

      TOCA 5: Toca 511 & Toca FC Versus Standard of Care in Patients With Recurrent High Grade Glioma (rHGG) 2019 SNO oral presentation
      https://tocagen.com/wp-content/uploa..._22Nov2019.pdf

      If you look at page 13, Toca seems to be promising for AA, IDH1 mutated at second recurrence. Is there any indication that Toca could be approved for IDH1 mutated gliomas, based on these results? Also, do you maybe know why IDH1 mutated anaplastic oligodendrogliomas aren't included?

      Thanks!

  • #4
    Onc-201: (Diclaimer: The Musella Foundaiton gave a venture philanthropy grant to this company so we will benefit if the drug gets approved). There were a LOT of presentations on this drug and a lot of excitement among the pediatric neuro-oncologists. The data just keeps getting better with something like 80% of patients having a benefit and no serious side effects. There were a few patients who had complete responses, and a few with more than 50% reduction in tumor - which is unheard of for this group of patients (H3K27M mutant diffuse midline glioma and DIPG). Although not a miracle cure, it is a huge step in the right direction. It was noted that in the original trial for glioblastoma, that patients with the H3K27M mutation did much better than those without it, so further development was limited to those with this mutation. About 80% of DIPG patients have it, as do diffuse midline gliomas in mostly young adults). However, a new bit of information came out. Those glioblastomas that did not respond at all, had elevated levels of EGFR. Most diffuse midline gliomas do not overexpress EGFR. This is way too early but brings up the opportunity to test a combination of Onc201 with a EGFR inhibitor, which might work on GBMs with high levels of EGFR! I doubt if this is ever going to get tested until after Onc-201 gets FDA approval but we have to remember to try this at that point!

    Comment


    • #5
      G47Delta oncolytic virus. This may be a home run. I wrote more about it on another thread. The trials were small but look good. I am working on finding out how to get it. If anyone has luck, let me know!

      Comment


      • #6
        Neo-adjuvant checkpoint inhibitors: There were a few presentations on this. Since they are approved we can get easy (unless you consider cost access anywhere. Basically it looks like if you start the checkpoint inhibitors when there is a lot of tumor, it will create a big immune response, but that immune response can't handle a large number of tumor cells. So the best stradegy seems to be start the checkpoint inhibitor when there is tumor, give it a little time to build up, then remove as much tumor as possible, either through surgery or radiation, then continue the checkpoint inhibitor. This is worth considering if you have time before a surgery.

        Comment


        • #7
          Immunotherapy: There were a lot of presentations on other vaccines and viral therapies. Most had good results but at this point we so not know which are best - so any of these trials really is worthwhile.

          Comment


          • #8
            Thanks Al for attending the SNO meeting and providing us with some promising treatment updates. I am very interested in finding out more on this G47Delta oncolytic therapy. Hope it gets moving fast here in the USA.

            Comment


            • #9
              Any update on VAL-083?

              Comment


              • #10
                Any good news regarding combinational treatments with Optune?

                Comment


                • #11
                  Originally posted by Harvey View Post
                  Any good news regarding combinational treatments with Optune?
                  There were 43 presentations on Optune! See the list at https://www.novocure.com/novocure-an...euro-oncology/

                  You can go to https://academic.oup.com/neuro-oncol...6/vi48/5619634 and use the search boc on the right side of the masthead to search for the abstract number. For example
                  CSIG-20 In the search results, click on the 2019 abstract (they reuse the numbers each year and list the oldest ones first)

                  Can you take a look and let me know what you find? The next news blast has a few highlights but let me know what you think first!

                  Comment


                  • #12
                    Originally posted by Harvey View Post
                    Any update on VAL-083?
                    Funny you ask! They had some good results for newly diagnosed MGMT unmethylated GBM! https://academic.oup.com/neuro-oncol...dFrom=fulltext

                    Looks like it might be time to replace Temodar with Val-083 for the unmethylated MGMT patients.

                    Comment


                    • #13
                      Just wanted to thank you very much for sharing as I wasn't able to attend.

                      Comment


                      • #14
                        Regarding Optune, here the most interesting topics (not only SNO 2019)

                        1. Array layout which increases field strength:
                        https://academic.oup.com/neuro-oncol...6/vi93/5154511

                        I myself am using this layout every other change for a year now (since I don’t like a monotone treatment, it’s better for the scalp, I.e. compliance, and the fields strength should be higher)
                        I noticed that I have stronger headaches when I use obligue layout. So it’s a sign for me it is really a higher electrical intensity.

                        2. Very interesting article for people considering (parts of CUSP protocoll). A year ago in separate articles was said the same substance is increasing endoplasmic reticulum stress and therefore should act in an (additionall) synergy with Optune. I myself was doing this combination for months (aprox. A year and half ago), but I got tired of (standard) medications, so I stopped taking medications alltogether.
                        https://academic.oup.com/neuro-oncology/article-abstract/21/Supplement_6/vi95/5619854

                        3. Another article suggesting Optune induced ICB - a hallmark of successful immunotherapy. For me a clear sign there is a synergy between Optune and other immunotherapies if combined together (Viral therapy + DC Vaccination + CPI)


                        https://academic.oup.com/neuro-oncol...dFrom=fulltext

                        4. Another article suggesting potential synergy between Optune and CPI - I would consider this especially in the neoadjuvant setting plus targeted craniotomy

                        https://academic.oup.com/neuro-oncology/article-abstract/21/Supplement_6/vi10/5620306?redirectedFrom=fulltext

                        5. Targeted craniotomy - I would do this in ANY case with smaller holes than in the study from dr. Korshoj (it’s really simple/isn’t a big risk/no problem for the surgeon


                        https://academic.oup.com/neuro-oncol.../vi239/5619156


                        Comment


                        • #15
                          They wouldn't tell me anything secret. The only data they showed was what Dr Liau presented at prior meetings. Nothing new. I get the feeling that it will be good. The longer they wait the better it looks/


                          Originally posted by Elvisdk View Post
                          Dear Dr. Albert Musella

                          Dear Dr. Musella. You attended the Patient Advocacy Meeting that Northwest Bio hosted at the SNO Conference on November 23rd.
                          And I have some questions regarding your point of view and experience with NWBOs DCVax-L fase 3.
                          1: Who did you talk to at the NWBO meeting?
                          2: What was your feeling about the time perspective on SAP, data lock and regarding unblinding?
                          3: With your broad and nuanced experience with GMB, what does your intuition say about PFS as a success criteria?
                          Thank you in avance.
                          Per Nielsen Denmark😊

                          Comment


                          • netopolis
                            netopolis commented
                            Editing a comment
                            Does anyone know if they still offer compassionate use program for DCVax-L? Thanks
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