Comment by femto
I've just read "Brainstorm" the recent biography by Richard Scolyer, the melanoma researcher who has survived 18 months, possibly due to a novel immunotherapy regime. It's worth a read, especially chapter 8, about his GBM treatment.
My takeaways:
* His treatment is an experiment. It's based on techniques regularly used in melanoma treatment, but which have not previously been used for brain cancers. Clinical trials are required to tell if the success to date is due to good luck or the treatment.
* There was/is a real chance of death due to complications, particularly brain swelling or damage to other organs, from the immunotherapy. There have been complications, including liver toxicity, but the book gives the impression that these have been managed.
* The drugs themselves are commercially available, the three immunotherapy drugs used (Anti-PD-1, Anti-CTLA-4, Anti-LAG-3) being "off the shelf" and the customised vaccine was manufactured by a US based company (not a research lab).
* A major barrier to someone else trying this treatment regime is finding a medical team willing to take the risk. That was probably the biggest reason Scolyer was able to access this treatment whereas others might struggle: he and his collaborator, Georgina Long, were able to convince others that it had a reasonable chance of working.
* The novel part of the treatment was delaying the usual brain surgery and steroids and not doing chemotherapy. Instead an immediate treatment was done with immunotherapty drugs, results showing that there was no "blood-brain barrier" that stopped them from working. After about 2 weeks, surgery was performed to remove the bulk of the tumour with minimal cutting into the healthy brain. Radiotherapy was then used, along with a continuing course of the immunotherapy and a course of a vaccine customised to the genetics of Scolyer's tumour.
* Planning is underway to run clinical trials, involving research institutes in Melbourne and the US and a pharmaceutical company, to test whether the results on Scolyer are reproducible.
Preprint of the publication:
"Neoadjuvant Triplet Immune Checkpoint Blockade in Newly Diagnosed Glioblastoma" (this is the paper that documents Scolyer's treatment and results to April 2024)