It's neo-adjuvant (treat prior to surgery) with a three mAbs: Ipi + Nivo, which is a well established combo of immunotherapeutics for many solid tumors, rounded out with relatlimab which I'm less familiar with (LAG-3 inhibition). Neoadjuvant use of immunotherapies is established concept and is utilized in clinical practice for non-small cell lung cancer and colon cancer. This is the first time I've seen a use of 3 immunotherapies used at once: Ipi + Nivo isn't the most tolerable treatment regimen. Other novel aspect is use of neoadjuvant therapy in GBM.
Don’t mean to hijack this thread, but I don’t think HN has DMs. Read some of your comments and as a person with cancer would love to pick your brain a little to develop my mental model further (and of course wouldn’t expect anything for free.) Drop me a line at [my HN username] [at] nearby.org if open to discussing more. Thanks!
Do they give immunotherapy before, after or instead of chemo? Asking because I heard what it is after in some cases and that puzzled me as chemo usually hits immune system.
No chemo. The entire idea of this regime is to hit the tumour with immuno to get the reaction. They want lots of tumour cells and for it to be "treatment naive" - Richard hadn't even had corticosteroids, which dampens immune.
Once they primed his system they excised as much as possible and kept the immuno going while doing a course of radiation.
Profs Long and Scolyer work with melanoma where chemo is rarely used these days.
That was a concern in the early days of development of anti PD(L)-1 agents - that chemo and even steroids would harm the T-cells you’re trying to activate.
Yet there are settings where a deliberate combination of anti PD-1 with chemotherapy is the standard of care. And there are other types of immunotherapy where a combination with chemotherapy is advantageous too.
From what I read (in a book written by Scolyer), the treatment didn't involve chemo. It was along the lines of:
1. immunotherapy
2. Surgery to remove the bulk of the tumour.
3. More immunotherapy
4. Radiation therapy
5. A course of vaccine customised to the genome of the cancer
I would like to see a clinical trial with patients who have Stage 4 disease being treated with multiple immunotherapies, up to 5 or 6 IV and oral immunotherapies. Why are we holding back in a population with poor prognosis??
As far as legislation, we should pass "Right to Try" laws. Allowing anyone with Stage 3 or 4 to pick an immunotherapy regardless of whether it's been approved. We should never allow hope to die!
There is a bound on the degree to which terminal patients are willing to be human guinea pigs, and a bound on which the data is statistically useful to anyone.
I’ve read many reports of terminal patients who wish that they hadn’t wasted the last few months of their healthspan searching for Hail Mary treatment options. If you were to ask yourself what you would do with 1-3 months of healthy life left, would you spend it in a hospital on chemo?
I’m no longer NED from Stage IV colon cancer (first DX 2014), and now it’s returned and inoperable. I was given an option to add Cetuximab which I’d had previously- but the side effects from that were so bad for me that it absolutely isn’t worth it to me to add a few months, but live in misery.
You are not just fighting for yourself, you are fighting for all future generations by helping to contribute toward finding a cure, even if you don’t benefit it from it. It is a noble cause, like going to war to defend your country.
If you only want to contribute toward things if they benefit you, then the real cancer is you.
Of course you would make different choices if you could predict the future. But if I only have 1-3 months to live, I am going for Hail Mary treatment options to try to extend that (because I can't predict the future).
Whilst this would be great, can I just temper this with a little understanding of how significant some of the side effects of the immunotherapies can be. There are significant limits on how much you can stress an already significantly stressed body and immunotherapy side effects can be WILD
Presumably this is the Richard Scolyer case, if anyone was curious.
A brief lookup indicates he could possibly be seeing recurrence; hopefully that's not the case but this is something that many people have said about his trial. We can't say for sure this treatment is going to be broadly effective without more time and experiments.
We love to debate headlines, don’t we? But along those lines, it seems like they could just say it’s “new” and that would be good enough; a headline doesn’t need to be any more specific.
This one is an unusual case, as the clinical trial is coming after the first patient (Scolyer) was treated. It's also interesting due to its aspect of "Physician, heal thyself", as Scolyer's own research formed the basis of his treatment. Scolyer doesn't seem to have been directly involved in his treatment, in that it was designed by his collaborator, Georgina Long, and executed by another team.
It's always cancer treatments and battery technology that gets pushed to the top of tech news sites for some reason but it never results in a "this problem is now fixed". Battery tech is incremental at best and nowadays may suffer from its own scale, that is, billions invested into battery factories set up to churn out batteries using a certain technique, which disincentivises new techniques.
But with batteries I like to think there's still plenty of investor money and healthy competition, so a large scale solid state battery plant may yet come to be.
This might be related with the case of Richard Scolyer, the Australian pathologist diagnosed with Glioblastoma. He was receiving some kind of experimental treatment for it.
I believe he got just got either Ipilimumab and Nivolumab as a combo therapy or Pembrolizumab. He's a researcher who focuses on neo-adjuvant (use therapy before resection) therapy in melanomas. It was a good gamble to try the same paradigm in Glioblastomas
Readit News
Once they primed his system they excised as much as possible and kept the immuno going while doing a course of radiation.
Profs Long and Scolyer work with melanoma where chemo is rarely used these days.
Yet there are settings where a deliberate combination of anti PD-1 with chemotherapy is the standard of care. And there are other types of immunotherapy where a combination with chemotherapy is advantageous too.
As far as legislation, we should pass "Right to Try" laws. Allowing anyone with Stage 3 or 4 to pick an immunotherapy regardless of whether it's been approved. We should never allow hope to die!
I’ve read many reports of terminal patients who wish that they hadn’t wasted the last few months of their healthspan searching for Hail Mary treatment options. If you were to ask yourself what you would do with 1-3 months of healthy life left, would you spend it in a hospital on chemo?
If you only want to contribute toward things if they benefit you, then the real cancer is you.
A brief lookup indicates he could possibly be seeing recurrence; hopefully that's not the case but this is something that many people have said about his trial. We can't say for sure this treatment is going to be broadly effective without more time and experiments.
It’s not. Of course.
It may be the first triple immunotherapy (3 checkpoint inhibitors), given in a neo-adjuvant setting, in glioblastoma.
Still cool, less catchy
(Or maybe I don’t understand “world-first” ?)
> It is the first documented use of neoadjuvant triple immunotherapy in glioblastoma
If the headline read "world's first" then it would imply what you understood
It’s a specific treatment being evaluated not just some pathways discovered in rodents that looks promising.
But with batteries I like to think there's still plenty of investor money and healthy competition, so a large scale solid state battery plant may yet come to be.
Ipi/nivo/relatlimab and then a peptide vaccine that they haven't written up yet.