Expert: Claes-Gustaf Nordquist, M.D. - 6/11/2008

Question
QUESTION: Dear Dr. Nordquist,
Last week, on or near June 3, 2008, Duke University and M. D. Anderson in the U. S. announced the results of a joint study on glioma treatment in which a viral agent/vaccine was used to boost the immune system and increase patient longevity.  According to the news reports on msnbc, patients in these two small trials (c. 20 people in each) lived on average 33 months rather than 14, and it took much longer for tumors to grow back after surgery--16.5 months as opposed to 6 months.  My 75-year-old brother-in-law has just had a 98+% resection of a very large GBM (right parietal lobe) and is trying to decide whether to begin the standard adjuvant therapy (Temodar and radiation) or to try a more aggressive approach combining standard therapy with the viral agent.  The news reports I've read about this trial do not provide specific information as to treatment success correlated with patient age or any other factors.  (It sounds to me like the completion of a Phase II trial.)  The study of the effectiveness of this agent will now proceed to a Phase III trial, with large numbers of patients at 24 U. S. facilities randomized so that 2 out of 3 subjects will receive the vaccine.  I'm not certain, but the specific agent may be CDX 110.  Would you please offer your opinion on this recent "breakthrough"?  I would also greatly appreciate any information you could share about this study.  Thank you very much.

ANSWER: Well, the normal malignant brain tumor treatment results are in reality so bad that I'm tempted to tell you to accept ANYTHING else that at least seems to be better! However a bit of caution is still probably relevant at least for the sake of not being over optimistic. First of all these trials are small. They need to be confirmed! Furthermore, yes they are better but in reality not dramatically so. Still NO cures only a prolonged survival, which is fine of course but we would like to see at least a few cures. But they are still completely absent! That is about all I can tell you at present! But again by all means if possible try it! I see no way he can lose anything by trying with the situation the way it is! Good luck!


---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Nordquist,
Again, thank you very much for your answer to my question.  I'm passing along your response to my brother-in-law.  I'd also like to ask you if you might be able to share any additional, more detailed information you may have about this study, or perhaps suggest how I might go about learning the patient population in the trials, viral-agent side effects, and so on.  I don't know whether this trial has excited the national and international neurological community, or whether it is just another of many similar studies that seem promising in Phase II but not in Phase III.  The only information I have been able to get is from general news releases (due, no doubt to U. S. Senator Kennedy's recent diagnosis/surgery), along with internet searches for CDX 110 (if that is, in fact, the viral agent being used), etc.  Again, I will be very appreciative of any additional information you might be able to provide.

Answer
Actually I do not have much more additional information unfortunately. There are several studies going on with virus infections of brain tumors. But none so far - as far as I know - have been able to show any really revolutionary new results. There are also trials of neutron radiation combined with boron accumulation in the tumor tissues to enhance the radiation effect there. Rather successful trials of that therapy for other head & neck tumors have been done in Finland but so far I'm not aware of any success with brain tumors. Malignant brain tumors are really a very sad area with regards to therapy where not much has happened for a long time. We do need a breakthrough there!