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60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Integration of DC vaccination in the primary treatment of adults with GBM: Update of the Pilot-Trial and the HGG-2006 phase I/II trial

Meeting Abstract

  • A. Hilko - Department of Neurosurgery, University Hospital Leuven, Belgium
  • S. van Gool - Dept. Pediatric Oncology, University Hospital Leuven, Belgium
  • W. Maes - Laboratory of Experimental Immunology, Catholic University Leuven, Belgium
  • F. van Calenbergh - Department of Neurosurgery, University Hospital Leuven, Belgium
  • J. Goffin - Department of Neurosurgery, University Hospital Leuven, Belgium
  • J. van Loon - Department of Neurosurgery, University Hospital Leuven, Belgium
  • S. de Vleeschouwer - Department of Neurosurgery, University Hospital Leuven, Belgium

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.09-02

DOI: 10.3205/09dgnc231, URN: urn:nbn:de:0183-09dgnc2316

Veröffentlicht: 20. Mai 2009

© 2009 Hilko et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: In spite of neurosurgery, radiochemotherapy (RCT) and maintenance temozolomide chemotherapy (TZMm), the prognosis of patients with GBM remains poor. Because immunotherapy opened new perspectives for patients at time of relapse, we are integrating immunotherapy in the primary postoperative treatment (Stupp regimen) for 60 adults (per protocol) with GBM (WHO grade IV) on reference pathology as a phase I/II protocol HGG-2006.

Methods: After (sub)total resection, leukapheresis is performed prior to radiochemotherapy (RCT), and 4 weekly vaccinations with autologous GBM lysate-loaded dendritic cells are given after RCT. Boosts with GBM lysates are given during TMZm. Immunomonitoring, feasibility and toxicity, as well as progression free (PFS) and overall (OS) survival are assessed. National Cancer Institute Common Toxicity Criteria were used to grade the adverse events.

Results: Serious adverse events during FU included an ischemic cerebral event, epilepsy with humerus fracture after fall due to epileptic fit, grade IV thrombopenia, short bowel perforation and cerebral abcess. ELISPOT for tumor antigen-reacting IFN-γ-producing T cells was performed on stored blood samples at different time points and results are underway. In the pilot study, the patients (n=8) with an actual FU of 32 months had a median PFS of 17.8 months and median OS 24.3 months, with 3-year OS of 37.5%. In the phase I/II trial, with a median FU of 11.3 months, the preliminary median PFS = 11 months and median OS = 17.3 months for the per protocol analysis (n=53). At the time of the joint meeting, data will be available for the full study group.

Conclusions: Tumor vaccination integrated within the standard primary postoperative treatment for patients with newly diagnosed malignant glioma is feasible, well tolerated and possibly beneficial for patients with minimal residual tumor burden. These early experiences with postoperative radio-chemo-immunotherapy provide good hope that integrating immunotherapy as a fourth treatment modality in patients with primary diagnosis of high-grade glioma might result in a better disease control.