The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

ASCO 2016 Review Neuro-Oncology Update Vinay Puduvalli, MD Professor and Director, Division of Neuro-oncology June 18, 2016

Overview § Glioblastoma § Anaplastic Gliomas § Low grade glioma § Brain mets § Basic and Translational science update

2

Newly Diagnosed GBM in Elderly §  A Randomized Phase III Study of Temozolomide and Short-Course Radiation vs. Short-Course

Radiation Alone in the Treatment of newly diagnosed Glioblastoma in Elderly Patients.

3

Recurrent Glioblastoma §  EORTC 26101: Phase III trial exploring the combination of bevacizumab

and lomustine in patients with first progression of a glioblastoma

4

Anaplastic Glioma -1p/19q intact -CATNON §  EORTC 26053-22054: Results of the interim analysis of the EORTC randomized phase III

CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q co-deletion: An Intergroup trial.

5

Brain metastases §  JCOG0504: A phase III randomized trial of surgery with whole brain radiation therapy versus

surgery with salvage stereotactic radiosurgery in patients with 1 to 4 brain metastases – a non-inferiority trial.

6 For patients with 1-4 brain mets, could SRS could be the new standard of care?

Other notable Reports

§  Nivo and Ipi in Recurrent GBM: §  Cohort 1: Randomized 1:1 to receive nivo 3 mg/kg (N3) q 2 weeks or nivo 1 mg/kg + ipi 3 mg/kg

q3 weeks (N1+I3) for 4 doses followed by N3 q2 weeks. §  Cohort 1b: nivo 3 mg/kg + ipi 1 mg/kg Q3W (N3+I1) for 4 doses followed by N3 Q2W §  The 12-month OS was 40% (95% CI: 12–67) for N3, 30% (95% CI: 7–58) for N1+I3, and 25% (95%

CI: 8–48) for N3+I1 (Historical values ~ 15% but numbers are small and should be cautiously interpreted)

§  Tolerability profiles in pts receiving nivo and nivo + ipi are consistent with observations in other tumor types, with no new safety signals. N3 was the best tolerated, and N3+I1 was better tolerated than N1+I3

§  Comprehensive mutation analysis in NRG Oncology/RTOG 9802: A phase III study of RT vs RT + PCV in high-risk low-grade gliomas (LGGs).

§  Comprehensive mutation analysis in NRG Oncology/RTOG 9813: A phase III trial of RT + TMZ vs RT + NU for anaplastic astrocytoma and mixed anaplastic oligoastrocytoma (Astrocytoma Dominant).

7

Take Home Messages §  Newly Diagnosed GBM in the Elderly with good functional status – chemoRT and

adjuvant chemo with TMZ is the new standard of care

§  Recurrent GBM in Adults: No survival advantage to adding CCNU to Bevacizumab

§  Newly Diagnosed 1p/19q Nondeleted Anaplastic Glioma: Adjuvant Temozolomide provides survival benefit. Whether concurrent TMZ if needed or not is not yet known.

§  For 1-4 brain mets, use of SRS alone is not inferior to WBRT in patients with lesions that are amenable to surgery

§  Several new exciting treatment strategies and marker analyses are in the works – results awaited over the next few years

8

Thank You To learn more about Ohio State’s cancer program, please visit cancer.osu.edu or

follow us in social media:

9