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Return to Can a Vaccine Stop Brain Cancer from Recurring? Overview

More on Can a Vaccine Stop Brain Cancer from Recurring?

Can a Vaccine Stop Brain Cancer from Recurring?

New York, NY (Sep 25, 2009)

Illustration of a human brain

Glioma, the most common and most deadly type of malignant brain tumor, is devastating for patients and their families. Patients treated with the current standard form of therapy – which includes surgery to remove as much tumor as possible, radiation therapy, and the chemotherapeutic drug temozolomide – usually live only about a year or more. Researchers at NewYork-Presbyterian Hospital and many other institutions are working toward more effective treatments for glioma, including those that harness the body's own disease-fighting machinery, the immune system.

Building on the promising results of earlier trials of a therapeutic vaccine called CDX-110, Theodore Schwartz, MD, a neurosurgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and Rose Lai, MD, a neuro-oncologist at NewYork-Presbyterian Hospital/Columbia University Medical Center are both enrolling patients in a new trial to test the effectiveness of the vaccine. CDX-110 targets a protein found on the surface of glioma cells in about a quarter of patients with the disease. The protein is a growth factor receptor called EGFRvIII.

Drs. Theodore Schwartz and Rose Lai

Therapeutic vaccines like CDX-110 are designed to work by training the immune system to recognize specific proteins found only on cancer cells as foreign, and to attack those cells as though they were infectious invaders.

A number of patients who participated in earlier trials of the vaccine did very well for 1½ to two years, said Dr. Lai, with significant improvements in both time until the disease progressed and in their length of survival, she said. "In the earlier trial the survival benefit is considerable," Dr. Lai said.

The new study (called ACT III) will look at the effectiveness of CDX-110 plus temozolomide in patients newly diagnosed with glioma. "Patients will first have surgery to remove the tumor, and then they go into the standard of care therapy, six weeks of radiation and temozolomide," said Dr. Schwartz. "Two weeks after that's complete they get their first of three injections of the vaccine, each two weeks apart." Patients will continue to get one injection per month for the rest of their lives along with temozolomide once a month as maintenance therapy, Dr. Schwartz said.

Dr. Lai is aiming to recruit up to 20 patients in the trial, but added that the study has strict guidelines about who is eligible to enroll. "It's by no means a very easy trial to get into – we're very vigilant in our screening of patients," she said. Patients are not eligible if they have undergone chemotherapy and radiation and still have a tumor larger than 1 cm or have more than one tumor.

Timing issues are also important for entering this trial, Dr. Lai said. "The patient would probably have to be screened before they start chemo-radiation to have a chance to get into the trial because the study starts two weeks after the completion of chemo-radiation." The major criterion is that patients must have the tumor protein that is the vaccine's target.

Patients in earlier CDX-110 studies eventually had progressive disease. When these patients had further surgery to remove tumor tissue, the tumor no longer showed the expression of EGFRvIII, the target protein, said Dr. Lai. "The vaccine is actually effective in targeting EGFRvIII. While patients do recur somewhere down the road, it seems like the vaccine has been able to postpone the recurrence until much later."

"The most important thing is that this trial really gives hope to a disease that doesn't have a lot of hope. We're working every day to try to improve the outcomes of patients with glioma, and this is just one of many avenues of investigation that we are pursuing at NewYork-Presbyterian Hospital," said Dr. Schwartz.

Some patients who do recur may be eligible for another vaccine trial recently opened at NewYork-Presbyterian Hospital. Neurosurgeon Jeffrey Bruce, MD, has begun enrolling patients in a vaccine trial using a heat shock protein for patients with recurrent glioma. Patients whose tumors recur after the CDX-110 trial may be eligible to participate in that study.

The study is sponsored by Celldex Therapeutics Inc. of Phillipsburg, NJ.

Contributing faculty for this article:

Theodore H. Schwartz, MD is an Associate Attending Neurosurgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and an Associate Professor of Neurological Surgery, Surgical Director of the Comprehensive Epilepsy Center, and Co-Director of the Institute for Minimally Invasive Skull Base Surgery at Weill Cornell Medical College.

Rose Lai, MD is an Assistant Attending Neurologist at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Neurology in the Division of Neuro-Oncology at Columbia University College of Physicians and Surgeons.

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