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National brain tumour research funding needs to increase to £30-35 million a year

Immune checkpoint inhibitors, elderly patients, 3D brain models and a research opportunity - Research news update

Dexamethasone, is a strong drug used to lower inflammation in the body and is often prescribed to patients with glioblastoma to treat symptoms related to cerebral edema, or swelling in the brain. A new study has looked at that clinical practice, particularly in the immunotherapy era, to determine if there could be negative consequences associated with dexamethasone use among patients with glioblastoma treated with immune checkpoint inhibitors. The conclusions were that among patients with glioblastoma receiving an immune checkpoint inhibitor, those who received the corticosteroid dexamethasone at baseline for cerebral edema had significantly worse overall survival.

Now we know about then the question is; “Does programmed cell death 1 immune checkpoint inhibition with nivolumab improve overall survival compared with bevacizumab treatment for patients with recurrent glioblastoma? “ It would appear from this study that the answer is no - nivolumab monotherapy did not improve overall survival compared with bevacizumab in the treatment of recurrent glioblastoma.

Neuro-oncology researchers and health care providers recognize that working together globally across all brain and spine cancers is the most effective path forward to improve treatments and outcomes. Researchers and health care providers took a giant step on that path in a virtual meeting with the Society for Neuro-Oncology (SNO). With nearly 300 neuro-oncology professionals tuned-in, 11 speakers from four countries presented on important topics in the field – preclinical models, tumour classification and molecular analysis, clinical trial development and outcomes, and global collaborations. Within these topics, experts discussed advances, challenges and possible solutions.

After a pre-operative meeting with their doctor brain tumour patients were found to have a better recall of important information when computer-generated 3D brain models were used. Sixty-one individuals aged 18 to 60 from a variety of backgrounds attended a simulated pre-operative appointment as if they were to undergo low-grade glioma surgery. Using a pre-developed script, the neurosurgical doctor gave explanations aided with either 2D MRI scans, a 3D-printed physical model, or an identical three-dimensional virtual model, seen through a mobile device to be superimposed in the real world (known as ‘augmented reality’). Recall of important clinical information was greatest in the group who used the physical model, followed by the augmented reality model and then the 2D images.

Elderly patients with recurrent high-grade glioma receive a similar benefit from repeat radiation therapy as younger patients. Researchers looked at outcomes among 118 patients with recurrent high-grade glioma treated with re-irradiation between January 2013 and July 2019. Twenty-two percent of patients were 65 years or older and although older patients had worse overall survival in the longer term, in the recurrent setting, elderly patients had a similar overall survival to younger patients and repeat radiation was well tolerated, suggesting a role for re-irradiation in the elderly population.

Genetically engineered T cells have been successful in treating blood cancers but have yielded limited benefits in solid tumours. Scientists have explored different combination strategies to overcome the problem but faced disappointing efficacy or unacceptable side effects. Previous studies have shown that the tumour microenvironment, with its lack of oxygen and nutrients, poses a hostile metabolic state that impedes T-cell infiltration and proper functioning, contributing to the inability of the therapies to wage an attack on solid tumours. Now, two research teams have come up with potential solutions to this problem that have shown promise in models of glioblastoma.

Finally, a great opportunity for the right person to join Professor Silvia Marino working on brain tumours at the Blizard Institute www.nature.com/naturecareers

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