Repeated Brain Tumor Sampling Uncovers Treatment Response in Patients with Glioblastoma

A multi-institutional study from the Accelerating GBM Therapies Through Serial Biopsies TeamLab, led by investigators from the Mass General Brigham Cancer Institute, found that serially testing tumor samples can help detect when a cancer treatment is activating the immune system in recurrent glioblastoma (GBM), even when traditional imaging measures cannot. Their results are published in Science Translational Medicine.

GBM is the most aggressive type of brain cancer, known for growing and spreading quickly. It is challenging to treat and almost always comes back. But it can be hard to understand what's happening inside the tumor during treatment.

“Getting tissue from GBM patients is difficult because the brain is sensitive, the procedures are risky, and the tumors themselves are complex and change over time,” said E. Antonio Chiocca, MD, PhD, executive director of the Center for Tumors of the Nervous System at the Mass General Brigham Cancer Institute. “But studying the cancerous tissue itself is also the best way to understand how the tumor reacts to treatment.”

The study involved over 100 brain tumor scientists and clinicians from multiple hospitals, cancer institutes and universities across the United States and was conducted through a multi-institutional collaboration funded by Break Through Cancer. In the study, researchers collected 96 samples over four months from two patients with recurrent GBM in a clinical trial of a new immunotherapy, CAN-3110, which is a form of immunotherapy known as an oncolytic virus, specially engineered to selectively infect and kill tumor cells.

“Standard practice is to not serially sample a patient’s brain tumor as they undergo treatment but instead to take a sample only once before a treatment and then follow a patient’s response using MRI,” said Chiocca. “But this study’s findings suggest that this thinking and practice may need to change to revolutionize how patients can monitor their disease.”

The researchers used multi-omic analysis with data integration supported by Break Through Cancer’s Data Science Hub (DASH). They integrated data from many sources — genetic material, peptides in and around the tumor, metabolites, immune changes and protein signaling factors, and AI-enabled digital pathology, among others.

The serial samples showed that, over time, the drug changed the environment inside and around the tumor, even though the tumor appeared to be progressing on magnetic resonance imaging (MRI) scans. This may happen because the immune system causes swelling and inflammation, which can look like new or enlarging areas of contrast on a scan even when a tumor hasn’t grown, a phenomenon known as pseudoprogression.

If CAN-3110 therapy can reshape the microenvironment and activate the immune system, it may improve patient outcomes, according to the researchers. Of the two patients treated during the study, one showed evidence that the tumor was responding to therapy, while the other’s disease remained stable.

“The breadth and depth of data we generated from repeated tumor biopsies really underscore the value of this approach for studying how therapies work," said Chiocca, who emphasized the collaborative work of the entire team of brain specialists from across the country. "These results give us strong reason to adopt a new paradigm in GBM drug development — one that builds longitudinal sampling into clinical trials to capture real-time snapshots of how tumors respond to treatment over time. Although we reported results on just the first two patients from this trial, we are accruing 12 patients to further solidify our findings. We plan to adopt this clinical trial platform now for two additional and distinct vaccine immunotherapies.

Authorship: In addition to Chiocca, authors include Alexander L. Ling, Jennifer Gantchev, Michael C. Prabhu, Sreyashi Basu, Ryuhjin Ahn, Alicia D’Souza, Nafisa Masud, Anna Ball, Odysseas Nikas, Genaro R. Villa, Michael S. Regan, Gerard Baquer, Georges Ayoub, Charles A. Whittaker, Zaki Abou-Mrad, Andres Santos, Charles P. Couturier, Dina Elharouni, Jayne Vogelzang, Kenny K.H. Yu, Hong Chen, Zhong He, Wen Jiang, Calixto Hope Lucas, Haley E. Sax, Frederick F. Lang, Vinay K. Puduvalli, Viviane Tabar, Cameron Brennan, Adrienne Boire, Matthias Holdhoff, Chetan Bettegowda, Michael Cima, Isaac H. Solomon, Ying Yuan, Paul P. Tak, Padmanee Sharma, Forest M. White, Keith L. Ligon, Nathalie Y.R. Agar, David A. Reardon, and Giacomo Oliveira.

In addition to the authors, the following Accelerating GBM Therapies Through Serial Biopsies TeamLab members have contributed to conceptualization of the study, development of the methodology, clinical trial investigation, and conducting of the analysis: Jennifer Wiley, Kathryn Partridge, Rameen Beroukhim, Amanda Spearman, Ugonma N. Chukwueke, Patrick Y. Wen, Austin L.H. Chiocca, Sarah Frisken, Brian J. Coyne, Daniel Triggs, Kimberly L. Vasquez, Michal O. Nowicki, Himanshu Soni, Raziye Piranlioglu, Marco Mineo, Ana Montalvo Landivar, Sylwia A. Stopka, Md Amin Hossain, Seth W. Malinowski, Sonam Bhatia, Thomas Quinn, Marla J. Polk, Alexsandra B. Espejo, Jingjing Sun, Yulong Chen, Sonali Jindal, Jason T. Huse, Lisa Norberg, Sangeeta Goswami, Betty Y. Kim, Kadir C. Akdemir, Brittany Parker Kerrigan, Douglas Nielsen, Jian Hu, Pratibha Sharma, Chetna Wathoo, Gregory Buchold, Jiyong Liang, Stuart Levine, Qun Cao, Alexei Stortchevoi, Shahiba Ogilvie, Alexandra Giantini Larsen, Kelsey Hopland, Yuval Elhanati, Rachel Estrera, Isaiah Osei-Gyening, Tejus A. Bale, Christopher Douville, Jordina Rincon Torroella, Vasilena Gocheva, Francesca Barone, Jennifer Moliterno

Disclosures: Chiocca is an advisor to Bionaut Labs, Seneca Therapeutics, and Theriva, holds equity options in Bionaut Laboratories, Seneca Therapeutics, Ternalys Therapeutics, and ReIgnite Therapeutics, is co-founder and on the Board of Directors of Ternalys Therapeutics, provides unpaid scientific and clinical advice to several companies, and is a named inventor on patents related to oncolytic HSV1 licensed to Candel Therapeutics, Inc., which provides milestone and royalty payments to Brigham and Women’s Hospital. Additional author disclosures can be found in the paper.

Funding: This study was funded in part by Break Through Cancer (Cambridge, MA), National Cancer Institute (P01 CA163205, P01 CA236749), National Institutes of Health (R01NS110942), Candel Therapeutics, Inc. (in-kind support), and the Claudia Adams Barr Program for Innovative Cancer Research.

Paper cited: Ling AL et al. “Serial Multi-omics Uncovers Anti-Glioblastoma Responses Not Evident by Routine Clinical Analyses” Science Translational Medicine DOI: 10.1126/scitranslmed.adv2881