Individualized Multimodal Immunotherapy for Adults with IDH1 Wild-Type GBM: A Single Institute Experience

The standard of care for patients with primary glioblastoma multiforme consists of neurosurgery, radiochemotherapy, and maintenance chemotherapy. We added individualized multimodal immunotherapy to this treatment. During maintenance chemotherapy, immunogenic cell death immunotherapy (oncolytic virus injections and sessions of modulated electrohyperthermia) was inserted. After chemotherapy, active specific immunotherapy with dendritic cell vaccines (IO-Vac((R))) and modulatory immunotherapy were given. The manuscript describes the retrospective analysis of a group of 50 adults taken out of the database following a predefined clinical profile without further bias. We observed a clearly improved overall survival in comparison to published data. There were no major adverse reactions. The proposed treatment concept takes into account dynamic changes in tumor biology and tumor-host interaction, proposing an additional perspective besides the paradigm of protocol medicine in clinical trials. This report on real-world data has great scientific value and high relevance for patients. Synergistic activity between maintenance temozolomide (TMZm) and individualized multimodal immunotherapy (IMI) during/after first-line treatment has been suggested to improve the overall survival (OS) of adults with IDH1 wild-type MGMT promoter-unmethylated (unmeth) GBM. We expand the data and include the OS of MGMT promoter-methylated (meth) adults with GBM. Unmeth (10 f, 18 m) and meth (12 f, 10 m) patients treated between 27 May 2015 and 1 January 2022 were analyzed retrospectively. There were no differences in age (median: 48 y) or Karnofsky performance index (median: 80). The IMI consisted of 5-day immunogenic cell death (ICD) therapies during TMZm: Newcastle disease virus (NDV) bolus injections and sessions of modulated electrohyperthermia (mEHT); subsequent active specific immunotherapy: dendritic cell (DC) vaccines plus modulatory immunotherapy; and maintenance ICD therapy. There were no differences in the number of vaccines (median: 2), total number of DCs (median: 25.6 x 10(6)), number of NDV injections (median: 31), and number of mEHT sessions (median: 28) between both groups. The median OS of 28 unmeth patients was 22 m (2y-OS: 39%), confirming previous results. OS of 22 meth patients was significantly better (p = 0.0414) with 38 m (2y-OS: 81%). There were no major treatment-related adverse reactions. The addition of IMI during/after standard of care should be prospectively explored.