‘Incredibly excited’: Richard Scolyer hails new US trial for brain cancer

It is the news that former Australian of the Year Professor Richard Scolyer has been hoping to hear ever since he started an experimental treatment for brain cancer more than 2½ years ago: a world-first clinical trial to determine whether it can revolutionise the approach to glioblastoma has opened in the United States.

Australian medical oncologist Professor Mustafa Khasraw, from Duke University in North Carolina, is leading the trial to see whether immunotherapy drugs can help patients diagnosed with the same lethal brain tumour as the world-renowned pathologist and researcher.

“I’m incredibly excited that this trial has commenced,” Scolyer said. “It takes a long time to get trials over the line but to be actually recruiting patients in the United States – and hopefully here soon – means we can test out the drugs to see if they make a difference.”

Duke will join four other cancer centres in Los Angeles, San Francisco, Houston and New York in the two-stage trial.

The first stage will check the safety of the experimental treatment on a small number of newly diagnosed patients. The second will involve many more patients getting a random assignment of one or two immunotherapy drugs (Nivolumab and Relatlimab) before surgery, followed by combining them with more conventional treatments (radiotherapy and chemotherapy) after surgery.

Scolyer was diagnosed with a highly aggressive brain cancer – IDH wild-type glioblastoma – in mid-2023.

Knowing it was incurable, colleague and medical oncologist Professor Georgina Long proposed trying what she had learnt successfully treating advanced melanoma patients with immunotherapy.

It was a risky plan for her fellow co-medical director of Melanoma Institute Australia (Scolyer has since stepped down) that recognised that conventional treatment for brain cancer had barely changed in almost two decades.

“Even if it knocked a few months off [my life], it was going to give some very important information quickly,” he said. “That I’m still alive and functioning a long time after diagnosis certainly gives hope.”

Scolyer, the 2024 Australian of the Year with Long, was devastated when an operation revealed the tumour had returned last March, but he has defied expectations that he had just months to live.

While he believes he has continued to deteriorate, he has been training for a charity bike ride in Tasmania next month, interrupted by fracturing two ribs when he fell while running.

Scolyer hopes this country’s pioneering approach to brain cancer will have benefits to patients around the world.

“Well done to Georgina for forging ahead with this treatment and linking up with experts in neuro-oncology, bringing them together with ideas that have been pioneered in melanoma,” he said.

Khasraw, who is the study principal investigator, said the GIANT trial (for Glioblastoma Immunotherapy Advancement with Nivolumab and Relatlimab) was “team science” that was drawing together clinicians and scientists from many institutions around the world “to bring innovation and hope to patients”.

Three patients had been enrolled so far. A fourth is at the early screening stage.

While Khasraw hoped Scolyer would lead a very long life, he could not draw too many conclusions about his treatment from the fact that he is still alive.

“I’m a scientist,” he said. “I’m driven by data. In order to believe that something is truly effective, I need to see the clinical trial data.”

But Khasraw thought the trial was “absolutely a step in the right direction” for glioblastoma treatment.

“It’s a stepping stone to generate convincing data that this therapy or a similar therapy is likely to improve patient outcomes at the population level,” he said. “We don’t want one patient to do better. We want all patients to do better.”

Khasraw said he expected to know in about two years whether the treatment would be transformative.

A peer-reviewed paper on the treatment developed by Long, published in the international journal Nature Medicine last year, laid the groundwork for the trial.

In Australia, it will be conducted by researchers at the Brain Cancer Centre, founded by radio presenter Carrie Bickmore after her husband Greg Lange’s death from brain cancer in 2011.

The Australian leader will be Associate Professor Jim Whittle, a neuro-oncologist at Melbourne’s Peter MacCallum Cancer Centre who is co-head of research strategy at the centre.

The trial will recruit only newly diagnosed glioblastoma patients. It is believed immunotherapy has a better chance of working on tumours before they have been treated with radiotherapy or chemotherapy.