Early stage trials in immunotherapy and brain screening

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Published: 20 Oct 2018
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Dr Elena Garralda - Vall d'Hebron Institute of Oncology, Barcelona, Spain

Dr Elena Garralda speaks to ecancer at ESMO 2018 in Munich about her work in early stage clinical trials, including developing an index of markers for disease progression and hyperprogression.

She also discusses developing a screening programme for brain cancers beyond glioblastoma.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

This year at ESMO we have different presentations. I would highlight the first one, a new prognostic index that we have done in the phase I unit in Vall d’Hebron. As you are aware, there are different prognostic indexes already in phase I so what we have tried to do is unite the different factors that are affecting. So we are seeing albumin, LDH, we are seeing the number of metastatic sites, the presence or not of liver metastases and the lymphocyte to neutrophil count, and we have established a new tool that divides patients into good, intermediate and bad prognosis. What we actually see is that those patients that have a bad prognostic index really are not doing well in immunotherapy clinical trials and we should probably be looking for alternative options for these patients.

We have also continued our line of research in hyper-progressive disease. This is a phenomenon that has been described in immunotherapy although it’s not well known. What we have actually done is validated the Gustave Roussy definition that was the initial definition of this phenomenon in our cohort of patients. We have also observed these two definitions, so the new definition that Vall d’Hebron did and the definition of Gustave Roussy, in a cohort of patients treated with TKI, so not immunotherapy. What we very nicely observed is that even if the phenomenon appears, so there are patients that progress in a certain way, this phenomenon doesn’t appear to impact survival, differently from immunotherapy where we clearly see an impact in survival.

Then another area of research is in targeted therapies and I would highlight a poster that will be in a poster discussion session where we are analysing the impact of molecular pre-screening programmes in brain tumours other than glioblastoma. We are telling the experience in our centre and we are actually seeing that it’s worth screening these patients and that they can have targeted alterations and that they can go into clinical trials and also have benefit. So even if it’s a rare patient population it’s worth deriving them to phase I clinical units and having them molecularly pre-screened.