Oral + Rapid Oral – CNS

The sessions on neuro-oncology this year highlighted the persistent challenges in this domain. Despite a few practice-changing updates, Prof Dr Bart Neyns from the Vrije Universiteit Brussel reassures there is hope in the evolving landscape. 

The final analysis of the intergroup CATNON trial was presented. This trial, initiated over 15 years ago, has adapted to changes in glioma classification. It focused on patients with grade 3 astrocytomas, excluding those with 1p19q co-deleted oligodendrogliomas. The trial evaluated the role of concurrent and adjuvant temozolomide with radiotherapy. The final results show that the adjuvant temozolomide phase, consisting of 12 cycles, improves survival. Consequently, concurrent temozolomide during radiation can be safely omitted. IDH1 mutation analysis was not part of the trial’s initial design, but post hoc analyses support these conclusions. For patients with IDH1-mutant grade III gliomas, adjuvant temozolomide alone is now the standard. The number of cycles—12—remains untested against shorter regimens; however, it represents the current best practice.

Beyond CATNON, a trial tested a multitargeted TKI added to standard glioblastoma therapy. While progression-free survival improved, overall survival did not, echoing earlier VEGF-targeting studies. This likely limits the therapeutic potential of such approaches. 

Active immunotherapy efforts continue, but checkpoint inhibition with PD-1 blockers is not effective in glioblastoma. Phase one trials currently explore CAR-T cell therapy in recurrent glioblastoma. Data suggest CAR-T cells can kill these tumour cells, targeting specific mutations such as EGFRv3 or IL13Rα2. However, the duration of response remains variable. Some patients show encouraging durability of response. Still, these findings call for further refinement. Larger Phase 2 and Phase 3 trials are needed. These early studies reinforce that glioblastoma cells remain vulnerable to immunotherapy approaches. Progress is slow, but new strategies hold promise for the future.