• John Lynes, Sadhana Jackson, Victoria Sanchez, Gifty Dominah, Xiang Wang, Averie Kuek, Christina Piper Hayes, Sarah Benzo, Gretchen C Scott, Prashant Chittiboina, Kareem A Zaghloul, Deric M Park, Jing Wu, Christopher S Hourigan, Amber J Giles, Tianxia Wu, Dragan Maric, Jinguo Chen, Martha Quezado, John D Heiss, Mark R Gilbert, and Edjah K Nduom.
• Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
• Neurosurgery. 2019 Apr 1; 84 (4): 945-953.

BackgroundGlioblastoma is the most common primary malignancy of the brain, with a dismal prognosis. Immunomodulation via checkpoint inhibition has provided encouraging results in non-CNS malignancies, but prediction of responders has proven to be challenging in glioblastoma patients.ObjectiveTo determine the proportion of patients who have a measurable increase of interferon gamma levels in brain tumor tissue after their first dose of nivolumab, and to evaluate the safety of using brain tumor microdialysis to monitor for immune response while evaluating the safety of the combination of anti-programmed death 1 (PD-1) and anti-lymphocyte activation gene 3 (LAG-3) checkpoint inhibition.MethodsThe study design is a single-center, nonrandomized phase 1 clinical trial. Up to 15 adult patients with recurrent glioblastoma will be enrolled with the goal of 10 patients completing the trial over an anticipated 18 mo. Patients will undergo biopsy; placement of microdialysis catheters and lumbar drains; treatment with anti-PD-1 checkpoint inhibition; comprehensive immune biomarker collection; tumor resection; and then treatment with anti-PD-1 and anti-LAG-3 checkpoint inhibition until progression.Expected OutcomesWe expect interferon gamma levels to increase in the brain as measured via microdialysis in treated patients. Based on published reports, microdialysis in this patient population is expected to be safe, and anti-LAG-3 and anti-PD-1 combined will likely have a similar side effect profile to other checkpoint inhibitor combinations.DiscussionThe failure of recent trials of immune therapies in glioblastoma underscores the need to appropriately measure response in the treated tissue. This trial may provide insight on indicators of which patients will respond to immune therapy.Published by Oxford University Press on behalf of Congress of Neurological Surgeons 2018.

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