Clinical Trials Seek Advances in Treating Most Aggressive Type of Brain Tumor

Although there are more than 100 different types of brain tumors, glioblastomas are by far the most common. They’re also the most aggressive. Because the tumor cells reproduce rapidly, GBMs, as they are called, are highly malignant, recur often despite surgery, radiotherapy, and chemotherapy, and can quickly spread into other parts of the brain.

Approximately 15,000 Americans are diagnosed with glioblastoma each year; typically, patients live just 16 to 18 months after diagnosis, according to the Glioblastoma Research Foundation (GRF). Median age of diagnosis is 64 years and it is more common in men as compared to women.

According to radiation oncologist Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis Program at Baptist Health Miami Cancer Institute,

glioblastomas are difficult to treat because of their biological nature and extent of disease involvement in the brain.

Radiation oncologist Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis Program at Baptist Health Miami Cancer Institute

“These tumors infiltrate into the brain, making them hard to reach, and they also contain cells which are resistant to radiation therapy – even with escalated doses – and chemotherapy, which makes treatment a real challenge,” says Dr. Kotecha. Another challenge is the limited number of therapies available. Despite first being identified in scientific literature a century ago, there are today still only four FDA-approved drugs to treat the disease, the GRF notes.

Clinical trial studies novel therapies for glioblastomas

Dr. Kotecha aims to change this by studying how glioblastomas respond to novel therapies currently being tested in clinical trials at Miami Cancer Institute. Among the various studies he is leading, Dr. Kotecha serves as institutional principal investigator (PI) and national radiation oncology study chair for a phase II trial of glioblastoma patients with recurrent tumors, meaning their tumors came back after initial treatment.

This phase II trial studies the best dose and effect of two different monoclonal antibodies – tocilizumab in combination with atezolizumab – along with fractionated stereotactic radiation therapy. This uses special equipment to precisely deliver multiple, smaller doses of radiation spread over several treatment sessions (in this case, three) to the tumor.

“Therapy with fractionated stereotactic radiotherapy in combination with tocilizumab may suppress the inhibitory effect of immune cells surrounding the tumor and consequently allow an immunotherapy treatment by atezolizumab to activate the immune response against the tumor,” Dr. Kotecha explains.

The goal of the study is to change a tumor that is unresponsive to cancer therapy into a more responsive one, Dr. Kotecha says. “In patients with recurrent glioblastoma, combination therapy with tocilizumab, atezolizumab and fractionated stereotactic radiation therapy may shrink or stabilize the cancer better than radiation therapy or systemic therapy alone.”

200 different clinical trials now underway

Manmeet Ahluwalia, M.D., MBA, FASCO, Fernandez Family Foundation Endowed Chair in Cancer Research, deputy director, chief scientific officer and chief of solid tumor medical oncology at Miami Cancer Institute, points to Dr. Kotecha’s glioblastoma study as an example of the cutting-edge research the Institute undertakes in its mission to prolong and save the lives of cancer patients everywhere.

Manmeet Ahluwalia, M.D., MBA, FASCO, Fernandez Family Foundation Endowed Chair in Cancer Research, deputy director, chief scientific officer and chief of solid tumor medical oncology at Baptist Health Miami Cancer Institute

“We have approximately 200 open clinical trials now underway at Miami Cancer Institute, including several glioblastoma trials,” says Dr. Ahluwalia. “We are working with collaborators all over the globe to design and devise clinical trials that explore new protocols, continue to push drug development forward and provide innovative treatments for cancers of all types.”

Dr. Ahluwalia, who is the principal investigator for numerous glioblastoma trials, is also the recipient of a $3.9 million R01 grant from the National Institutes of Health for his glioblastoma research with Pallavi Tiwari, Ph.D., of the University of Wisconsin. Together, they have developed and evaluated image-based tools to determine the risk of cancer recurrence in glioblastoma.