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Complete response under treatment with proton therapy followed by chemotherapy together with Tumor Treating Fields in a biopsied IDH wildtype glioblastoma patient
EANS Academy. Stein M. 09/25/19; 275540; EP03102
Dr. Marco Stein
Dr. Marco Stein

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Abstract
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Background: Especially in Glioblastoma (GBM) IDH wildtype with unmethylated MGMT promotor therapeutic options are restricted. Here, we report on a patient with biopsied GBM IDH wildtype with complete radiological response.
Methods: Brain MRI demonstrated an occlusive hydrocephalus and a ring enhancing lesion in the right posterior thalamus in a 42 year old male. Endoscopic third ventriculostomy and stereotactic biopsy of the lesion were performed. Histopathological examination resulted in the diagnosis of a glioblastoma (WHO grade IV), IDH 1 wildtype (R132), IDH 2 wildtype (R172), HIST1H3B/C wildtype, TERT wildtype (C228 and C250), and unmethylated MGMT promotor. In view of the tumor site, resection was not feasible. Consequently, the patient received chemoradiation with TMZ to a total dose of 60Gy incl. proton boost of 5x2 GyRBE. TTFields therapy in combination with TMZ was initiated 4 weeks after completion of chemoradiation, TMZ maintenance was completed per protocol after 6 cycles. TTFields therapy was continued for more than 13 month and to-date the patient is still on therapy.
Results: Current follow up time is 16 months after initial diagnosis with the patient showing a radiological complete response. The first MRI following chemoradiation with TMZ and protons showed pseudoprogression. The TTFields usage (compliance) rate, of the patient was 86 %. This was well above the independent prognostic threshold of 75 % and supports the feasibility of this approach. In a MRI 4 months later, partial response with decreased contrast enhancement was observed. Another MRI after 3 months showed a complete response without perfusion signal in the tumor area.
Conclusion: Complete response was observed following combination treatment of chemoradiation with TMZ including proton boost, TMZ maintenance and TTFields in a patient with pathologically confirmed GBM IDH wildtype. To our knowledge, this is the first report on a GBM patient receiving proton therapy followed by TTFields therapy.
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