It's neo-adjuvant (treat prior to surgery) with a three mAbs: Ipi + Nivo, which is a well established combo of immunotherapeutics for many solid tumors, rounded out with relatlimab which I'm less familiar with (LAG-3 inhibition). Neoadjuvant use of immunotherapies is established concept and is utilized in clinical practice for non-small cell lung cancer and colon cancer. This is the first time I've seen a use of 3 immunotherapies used at once: Ipi + Nivo isn't the most tolerable treatment regimen. Other novel aspect is use of neoadjuvant therapy in GBM.
Don’t mean to hijack this thread, but I don’t think HN has DMs. Read some of your comments and as a person with cancer would love to pick your brain a little to develop my mental model further (and of course wouldn’t expect anything for free.) Drop me a line at [my HN username] [at] nearby.org if open to discussing more. Thanks!
Do they give immunotherapy before, after or instead of chemo? Asking because I heard what it is after in some cases and that puzzled me as chemo usually hits immune system.
No chemo. The entire idea of this regime is to hit the tumour with immuno to get the reaction. They want lots of tumour cells and for it to be "treatment naive" - Richard hadn't even had corticosteroids, which dampens immune.
Once they primed his system they excised as much as possible and kept the immuno going while doing a course of radiation.
Profs Long and Scolyer work with melanoma where chemo is rarely used these days.
That was a concern in the early days of development of anti PD(L)-1 agents - that chemo and even steroids would harm the T-cells you’re trying to activate.
Yet there are settings where a deliberate combination of anti PD-1 with chemotherapy is the standard of care. And there are other types of immunotherapy where a combination with chemotherapy is advantageous too.
From what I read (in a book written by Scolyer), the treatment didn't involve chemo. It was along the lines of:
1. immunotherapy
2. Surgery to remove the bulk of the tumour.
3. More immunotherapy
4. Radiation therapy
5. A course of vaccine customised to the genome of the cancer
