In Brain News, Research News

What we really know about Lisavanbulin and glioblastoma (GBM)

There was a headline in the press this weekend about a ‘miraculous brain cancer drug’ that ‘shrinks tumours by 90%’ (The Times 20 June 2021). Here’s what we really know.

What is the story behind lisavanbulin?

Personalised medicine is recognised to be the best way to treat cancers, not just brain cancer. This means that treatments are created and targeted to treat the molecular make up of cancer. The exciting news about lisavanbulin is that this could potentially be one of the first targeted treatments for glioblastoma, the most aggressive form of brain cancer, when it recurs.

And herein lies the problem. The brain is a delicate and privileged site and brain tumours are complex, rare and intrinsically resistant diseases. We know that when a GBM tumour recurs, it is not the same as initial disease. We know too that individual treatment agents in isolation are doomed to failure, because there are multiple growth pathways that must be inhibited simultaneously. In other words, the cancer cells keep finding ways to work around the treatment.

How is lisavanbulin having an impact?

lisavanbulin is a produced by Basilea Pharmaceutica Ltd, a biopharmaceutical company based in Switzerland. Data from GBM mouse models and recent phase 1 clinical data (Lopez et al. ESMO 2020) suggest that EB1 is a response-predictive marker for lisavanbulin in GBM. This means that GBM tumours with the molecular marker EB1 may respond to lisavanbulin. A phase 2 study is ongoing at The Royal Marsden to confirm this hypothesis. So far two patients have shown a positive response.

It is very early days and as ever with personalised medicine, it will only be meaningful for small cohorts of patients who have the predictive marker, in this case EB1. The reason this has made the headlines now is that the results were reported recently at The American Society of Clinical Oncology conference (ASCO). You can read more about the scientific aspects here.

Is this a game changer?

So potentially, yes – this may be a game changer. But – it is a long long way from coming to to the clinic and if it does, then it will only be suitable for a very small cohort of patients who have the EB1 predictive marker. We need to see the results for the phase 2 study. If these show promise then phase 3 and phase 4 studies will follow. At this point, if it is proven to be successful, the treatment will need to be approved by the National Institute for Health and Clinical Excellence so that it can be provided by the NHS. This too would mean a change in the way tumours are tested, as the GBM tissue will need to be tested for the EB1 predictive marker.

Summary

The bottom line is yes, lisavanbulin shows promise in the lab with mouse models and currently in just two patients. But we have so many hurdles to cross before it could potentially be used in the clinic. This will take years and of course, may fall at any of the hurdles, like so many other potential treatments have to date. So whilst partially accurate, our feeling is that this reporting builds false hope. Clinicians are not able to prescribe this treatment at the moment and they may never be able to. You can though access it through signing up to the trial. If you want to find out more then there is more information here.

The Royal Marsden in London and The Beatson in Glasgow are currently recruiting to be followed by University College London, and the Sir Bobby Robson Cancer Trials Research Centre; Northern Centre for Cancer Care in Newcastle. Do have a look at the inclusion and exclusion criteria – these are very stringent and of course, it is only appropriate for people who have the predictive marker EB1.

If you’re living with a brain tumour and have any questions around this latest news, or want to access support, give us a call on 01983 292 405 or email hello@brainstrust.org.uk

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Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerous. Non-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php