Dr. Lukas on Immunotherapy in Glioblastoma

Rimas V. Lukas, MD, associate professor of Neurology, director, Medical Neuro-Oncology, University of Chicago Medicine, discusses some of the exciting advances recently seen with immunotherapy in the treatment of patients with glioblastoma.

Nivolumab (Opdivo) has been recently evaluated in this setting in multiple clinical trials. One such ongoing study will randomize patients to one of 2 treatment arms. One arm will receive nivolumab monotherapy until surgical resection, while the other will receive nivolumab with dendritic cell (DC) vaccine therapy until surgical resection. During resection, blood and tumor samples will be assessed and compared. Following surgery, patients in both treatment arms will continue to receive DC vaccines and nivolumab until confirmed disease progression. Primary outcome measures of this study include the safety of administering DC vaccines with nivolumab, as measured by the percentage of patients who experience unacceptable toxicity during combination treatment.

Another area of interest, Lukas notes, is targeting IDO inhibition. One ongoing phase I/II study is currently examining the efficacy of indoximod, an IDO inhibitor, and temozolomide (Temodar) as a treatment for patients with glioblastoma. The overall goal of this trial is to provide a foundation for future studies with indoximod tested in newly diagnosed glioblastoma patients with radiation and temozolomide, or in combination with vaccine therapies.

According to Lukas, many oncologists are also interested in the utilization of not just blocking one checkpoint, but multiple checkpoints, and finding the best combination therapies, as well as using checkpoint blockade in conjunction with either traditional cytotoxic chemotherapies or antiangiogenic therapies.