Learnings from Pilot Study: Creating Treatment Templates to Serve More Glioblastoma Patients

A recent pilot study between Cancer Commons and the Musella Foundation for Brain Tumor Research & Information is identifying patterns that are being translated into treatment templates to better serve a larger group of GBM patients. Our Curious Dr. George asks Cancer Commons Scientist Adrienne Nugent, PhD, to discuss key factors that point to the best courses of action a patient might take, and about the clinical utility of a Virtual Tumor Board.

Curious Dr. George: Patients with postoperative Glioblastoma multiforme (GBM) are among the most difficult oncology cases to manage. In your work as a Clinical Scientist at Cancer Commons you have worked directly with many such registered patients/clients who seek the information and options that may help them. You coordinate neuro-oncologists who may constitute Virtual Tumor Boards. What are the key factors you seek to identify to determine what courses of action a patient might take and whether a Virtual Tumor Board may be helpful? Is a template useful?

Adrienne Nugent, PhD: As a Cancer Commons scientist, I feel very grateful to be able to work with such wonderful and inspiring patients and caregivers on a daily basis. The patients and families who have been handed the especially difficult diagnosis of Glioblastoma face myriad decisions and challenges due to the aggressive nature of the disease and the fact that the standard of care (SOC) treatment has not changed all that much since 2005.

Given the current outcomes with SOC, patients are encouraged to look for clinical trials and novel treatment options, but quickly face many barriers to accessing and enrolling in these more promising therapies. This lack of access to the latest developments in medicine and technology reflects a growing gap between many cancer patients and optimized precision cancer treatment.

To try and bridge this gap, Cancer Commons partnered with the Musella Foundation for Brain Tumor Research & Information to launch a pilot study for GBM patients. We provided 10 patients with complete review of their medical history by a Cancer Commons scientist and a virtual tumor board (VTB) comprised of three neuro-oncologists. The scientist identified a list of evidence-based treatment options and the VTB provided their recommendations based on a unique combination of factors for that patient.

Many valuable patterns emerged from this initial pilot study that we are now translating into treatment templates to better serve a larger group of GBM patients. The key features we’ve identified for creating templates of prioritized treatment options include:

• Location of the tumor(s): Tumors on the brain stem or involving leptomeningeal metastases are frequently excluded in clinical trials or have unique trials specifically for these conditions
• Eligibility for surgery and/or radiation: Some clinical trials involve a combination of systemic therapy, surgery, and/or radiation. Eligibility for further surgery or radiation must be determined by the treating neuro-oncologist, neurosurgeon, and radiation oncologist
• Treatment line: Newly diagnosed, on SOC or adjuvant therapy, at progression/recurrence, or on later-line treatment
• KPS/ECOG: Patient performance status based onKPS (Karnofsky Performance Status) or ECOG (Eastern Cooperative Oncology Group) scale. Most clinical trials will only accept patients with ECOG <2 or KPS >60 or 70
• Tumor biomarkers: MGMT methylation status, EGFR/PTEN/TERT alterations, NTRK/ROS1/FGFR oncogenic fusions, tumor mutation burden, PD-L1 expression
• Treatment history: Some trials restrict patients with specific prior treatments. In particular, prior Bevacizumab/Avastin treatment excludes patients from many, but not all, clinical trials
• Geographic location of the patient: Prioritization of trials near the patient’s home with the option for regional or nationwide trial search given the ability of the patient to travel
• Patient goals and quality of life: Prioritization of trials to meet the desires of the patients, such as identifying trials that avoid randomization to SOC, avoid chemotherapy at recurrence, require fewer hospital/clinic visits, involve oral rather than infusion treatments, etc.

When these features are known, we feel most GBM patients can benefit from our templated treatment recommendations without needing to convene a full VTB. However, VTBs can be particularly helpful for patients who do not have access to neuro-oncologists or are receiving conflicting information, such as if more surgery or radiation are indicated or if they have progression versus pseudoprogression. In these cases, a VTB can yield valuable insights to resolve open questions.

Dr. Nugent can be reached at adrienne.nugent@cancercommons.org.