News
19th Society for Neuro-Oncology Annual Meeting
Robert Landau/CORBIS
Published Online
November 21, 2014
http://dx.doi.org/10.1016/
S1470-2045(14)71126-X
The 19th annual meeting of the
Society for Neuro-Oncology was
held in Miami, FL, USA, on
Nov 13–16, 2014
18
Electric fields for glioblastoma
The use of the NovoTTF-100A
system (NovoTTF) for local delivery
of electric fields to patients with
newly diagnosed glioblastoma
receiving temozolomide significantly
improves treatment outcomes
compared with temozolomide alone.
Presenting data from an international,
multicentre randomised phase 3 trial,
Roger Stupp (Zurich, Switerland)
on behalf of his co-investigators
described outcomes from a planned
interim analysis of 315 patients
randomly assigned to receive either
NovoTTF plus temozolomide
(n=210) or temozolomide alone
(n=105). All patients receive upfront
radiotherapy plus temozolomide
before 2:1 randomisation to the two
treatment groups. Adverse events
were similar between the two groups
with the exception of skin irritation,
which was higher with NovoTTF
plus temozolomide. Progression-
free survival, the primary outcome,
was 7·1 months in the combination
group compared with 4·0 months
in the temozolomide alone group
(HR 0·63, p=0·001). Overall survival
was 19·6 months in the NovoTTF
plus temozolomide group versus
16·6 months in the control group
(HR 0·75, p=0·034). The data safety
monitoring committee have now
recommended that the trial is stopped
because of the substantial activity in
the experimental group.
ALK inhibitors for brain
metastases
ALK inhibitors for ALK-rearranged
non-small-cell lung cancer are now
the new standard of care in this
disease. However, advanced non-
small-cell lung cancer often presents
with brain metastases. The efficacy
of ALK inhibitors in this setting
is unknown. Analysing a subset
of patients in the ASCEND1 trial,
which investigated the second-
generation ALK inhibitor ceritinib,
Ranee Mehra (Philadelphia, PA, USA)
and colleagues found 124 patients
of the original 246 enrolled had
brain metastases at baseline. Median
progression-free survival among this
group was 6·9 months compared with
the 8·2 months reported for the entire
cohort in updated data presented
at ESMO 2014. Importantly, among
14 patients with measurable brain
lesions, seven showed a response
in their brain tumour and three had
stable disease, thus suggesting that
ceritinib can cross the blood–brain
barrier and has activity against brain
metastases. The trialists also found
that previous use of ALK inhibitors did
not affect response.
Rindopepimut vaccine for
relapsed glioblastoma
Results from the randomised ReACT
phase 2 trial show bevacizumab plus
a vaccine consisting of the EGFRvIII
peptide sequence conjugated to
keyhole limpet hemocyanin, and
delivered intradermally with GM-CSF,
can elicit significant improvements in
progression-free survival at 6 months
and in overall survival compared
with bevacizumab plus placebo.
David Reardon (Boston, MA, USA)
and colleagues found an objective
response rate of 23% among patients
treated with bevacizumab plus vaccine
versus 12% in patients treated with
bevacizumab plus placebo. Of the
115 patients treated, the main adverse
event was grade 1–2 reaction at the
injection site. Furthermore, Evangelia
Razis (Athens, Greece), presenting data
from a rindopepimut compassionate
use programme for patients not
eligible for ongoing trials, showed
the vaccine has activity among many
types of glioblastoma. A phase 3 trial
of rindopepimut will start soon.
Breast cancer drug active in
ependymoma
Mark Gilbert (Houston, TX, USA)
and fellow researchers have done a
www.thelancet.com/oncology Vol 16 January 2015
phase 2 trial of lapatinib and dose-
dense temozolomide for adults with
recurrent ependymoma. This cancer is
rare in adults and there is no standard
treatment. 50 patients were enrolled
into the study and had a mixture of
grades and CNS locations. Median
progression-free survival for the
entire group was 36 weeks, but this
differed by grade and location, with
ependymomas of the spinal cord
doing best: median progression-
free survival was 96 weeks and
80% of patients were still free from
progression at 6 months in this
subgroup of patients. Patients with
the highest expression of HER2 mRNA
seemed to respond best to treatment,
and patients only experienced modest
myelotoxicity and rash.
Dendritic-cell vaccine active in
newly diagnosed glioblastoma
According to Patrick Wen (Boston,
MA, USA) and colleagues, autologous
dendritic cells pulsed with six
synthetic peptide CTL epitopes
targeting the glioblastoma tumour/
stem cell-associated antigens,
MAGE-1, HER2, AIM-2, TRP-2,
gp100, and IL-13Rα2, followed by
maintenance temozolomide, signifi-
cantly improves progression-free
survival for patients with newly
diagnosed glioblastoma. In this
double-blinded, 2:1 randomised,
phase 2 trial, 124 patients received
either the vaccine or a control
formulation for 12 months after
standard tumour resection and
adjuvant temozolomide and radiation
therapy. Median progression-free
survival was significantly improved
in the vaccine group (HR 0·57,
p=0·01). There were no major adverse
events or effects on quality of life.
Patients with HLA-A2 tumours and
methylated MGMT seemed to have
the best response. A phase 3 trial will
soon begin enrolment.
David Collingridge