Newer, Alternative Treatment Methods May Improve Brain Tumor Care

Frances Chow, MD, spoke with CancerNetwork® about several ongoing trials that are assessing non-traditional forms of brain cancer treatment.

The TVAX vaccine—currently being evaluated in a randomized phase 2b trial (NCT05685004)—involves taking tissue from the patient’s tumor and using it to create a vaccine that is then administered to the patient to manage their disease.¹ Additionally, the vaccine also works to improve the patient’s immune system by extracting immune cells, expanding them, activating them, and then returning them to the body. This process, as she said, is multidisciplinary and requires the help of various physicians.

Chow, a neuro-oncologist at the University of Southern California (USC) Norris Comprehensive Cancer Center, part of Keck Medicine USC, and principal investigator for the National Cancer Institute’s Cancer Therapy Evaluation Program, also spoke about perillyl alcohol (NEO100), an aerosolized medicine inhaled directly through the nose into the brain that is supported by Thomas Chen, MD, PhD, a professor of neurological surgery and director of the Brain Tumor Center at Keck Hospital of USC. The medicine is currently under investigation in a phase 2 trial (NCT05023018) evaluating it in patients with meningioma and in a phase 1/2a trial (NCT02704858) investigating it in patients with grade III or IV IDH-mutant glioma.^2,3

Transcript:

There is the TVAX vaccine, which is the individualized vaccine in glioblastoma, and the way that works is that we’re taking the patient’s tumor during their original surgery, and we are using that as a vaccine to train the body to recognize [the tumor] as the foreign thing to attack. [There is potential for] combining therapies together. Not only would we create that vaccine out of [the patient’s] own tumor, but we could then take out the immune cells, expand them, activate them, and then feed them back into [the patient]. It’s a 2-step process to boost their immune system, specifically against the tumor. It’s a very multidisciplinary and collaborative process, and we’re working with our neurosurgeons, our pathologists, and our radiation oncologists to coordinate all this treatment and to offer the best care that we can to the patients.

In terms of the aerosolized medicine as a treatment for astrocytoma and meningioma, this was a therapy that was supported by one of our neurosurgeons at USC, [Tom Chen, MD, PhD]. He had this concept to aerosolize and deliver the drug directly from the nose to the brain. We’ve had former iterations of these clinical trials in the past. One was completed in [patients with] glioblastoma, and it showed that when they inhaled a molecule, it crossed the blood-brain barrier and was able to cause some cell damage.⁴ From that phase 1 study came these 2 additional studies, [with one] specifically looking at glioblastoma with IDH mutations. It’s a phase 2 [trial], so we’re assessing efficacy and whether it can prolong patient survival. [The agent is also being assessed] in meningiomas because we unfortunately don’t have an FDA-approved systemic therapy for [meningiomas]. Once a meningioma grows, despite surgery and radiation, we’re struggling to look for things to slow it down. Several meningiomas grow at the base of the brain, right behind the nose, and you’d think, “Oh, if we could just get something right [in the nose], maybe we can make an impact on those tumors and help those patients.”

References

1. Study of neoantigen-specific adoptive T cell therapy for newly diagnosed MGMT negative glioblastoma multiforme (GBM). ClinicalTrials.gov. Updated January 16, 2025. Accessed February 11, 2025. https://tinyurl.com/ycx3em5w
2. NEO100 and high-grade meningioma. ClinicalTrials.gov. Updated October 15, 2024. Accessed February 11, 2025. https://tinyurl.com/e7axrrdw
3. Safety and efficacy study in recurrent or progressive grade III or IV IDH1 mutated glioma. ClinicalTrials.gov. Updated December 9, 2024. Accessed February 11, 2025. https://tinyurl.com/mrzuhkpk
4. Schönthal AH, Peereboom DM, Wagle N, et al. Phase I trial of intranasal NEO100, highly purified perillyl alcohol, in adult patients with recurrent glioblastoma. Neurooncol Adv. 2021;3(1):vdab005. doi:10.1093/noajnl/vdab005