Australian Doctor : Can you explain your decision to undergo immunotherapy as a treatment for glioblastoma ?

It does this through a variety of mechanisms , but it leaves your normal brain cells alone , relatively , so that is the attraction of it .

have the same prognosis , and you will not be able to enjoy the remaining part of your life . Obviously , that would not be very good either .

surgery when there is more tumour on board .

We also know that , if you administer other drugs , particularly ster-

would do a core biopsy to make the diagnosis and then have surgery soon after .

But when we decided we were

But there is some concern around

In the end , Katie and I wrote two

oids and chemotherapy , it is less

going to go down this path of receiv-

Professor Scolyer : My wife , Katie , and I were in Poland for a series of

stimulating the immune system . As part of that , you will cause

long letters that explained the risks as we understood them and that we

likely to work in those settings . With brain cancer , the odds of it

ing combination immunotherapy before the tumour was debulked , we

research lectures . While showing us

swelling of the brain .

were willing to take them on .

working are lower .

knew we wanted to carry out proper

around the country , a friend and his wife took us into the mountainous region , which was spectacular .

The next day , I had the seizure — no doubt precipitated by gaining alti-

Obviously , if you raise the pressure within the brain , the brainstem can be pushed down into the vertebral column and spinal canal , which can kill you .

Australian Doctor : Why has there not been a greater push to trial immunotherapy in the context of brain cancers before now ?

It has a lot to do with the amount of neoantigens : the antigens on the surface of the tumour cells that the immune system can recognise and then mount an immune response .

research on it .

Instead of the core biopsy , I said to the surgeon , “ I want an open craniotomy biopsy to get enough tissue so we can perform really good

tude during the climb .

So that is the main worry .

There are many more of these in

research .”

We were staying in a ski town , where I had a CT scan , and then went

We know from our work in melanoma that the risks of it happening

Professor Scolyer : At the institute , we started in immunotherapy

melanoma than in brain cancer . This is related to what we call the

Obviously , it is more risky doing that , but it was worth the risk .

to Krakow — about 1.5 hours ’ drive

are not high .

around 10 years ago in the context of

tumour mutation burden within the

After the biopsy , I had the combi-

away — where they did MRI scans .

Professor Long has treated more

melanoma , and it is gradually being

melanoma .

nation immunotherapy , and then we

These showed this mass in my tem-

patients with immunotherapy than

used in other fields . It is already

Another factor we look for is

waited 12 days for the surgery .

poral lobe .

any other doctor in the world .

used in lung cancer , renal cell can-

the so-called interferon-gamma

So 16 days after the first craniot-

Katie got on the phone to Geor-

And when you are dealing with a

cer , head and neck cancer and many

signature .

omy , I had it debulked .

gina [ co-medical director of Mela-

cancer that is incurable , it feels like

others .

We know this is less in brain can-

In treating melanomas , we nor-

noma Institute Australia in Sydney ]

the right thing to do .

It has been trialled in some

cer , but it is not a 100 % predictor .

mally wait six weeks after com-

and sent her some images of the

The other thing doctors are wor-

patients who have had a recurrent

We see some melanoma patients

bination immunotherapy , but the

scans .

ried about is that you might be

brain cancer .

with a higher mutation burden and a

surgeon said it was too risky in my

Georgina showed them to a neu-

left with lifelong side effects from

But we know from our melanoma

higher interferon-gamma signature

case .

rosurgeon who is a friend and col-

treatment .

work that immunotherapy is much

who do not respond and vice versa ,

She said , with brain cancer , about

league — and the surgeon who ended

Even if you do not die quicker , you

more effective if it is given before

so it is still worth trying .

30 % of them just take off , and then

up operating on me . She was pretty convinced it was a glioblastoma .

We then spent four days in Poland trying to get home .

I think it was when Georgina picked us up from the airport that she suggested using immunotherapy on my brain cancer .

TWITTER

Professor Scolyer undergoing his latest FET – PET scan .

Australian Doctor : It has been eight months since your diagnosis . Is the treatment working ?

Professor Scolyer : After immunotherapy , we saw a marked change . There was a 10-fold increase in the

you are not going to be able to have surgery — basically that will be the end of it .

It took a bit of effort to get the neuro-oncology people on board to make this happen . People were nervous . As doctors we sign up to ‘ do no

It actually took a millisecond for

number of lymphocytes and the

harm ’, and people were concerned

me to say , “ Yep , let ’ s do it .”

types of immune cells that became

this may take my life sooner than

It was a great opportunity to use

activated to fight the tumour .

would be the case with standard

some of our knowledge and discov-

We also saw that one of the ther-

therapy .

eries in melanoma to see if we could

apies — anti-PD-1 therapy — had

I am not really having too many

make a difference in brain cancer ,

crossed the blood – brain barrier and

bad side effects .

where treatment basically has not

was attached to some lymphocytes .

My liver function tests have been

changed in 19 years .

Some people had suggested to

mildly abnormal , but most of that

So for me — and I should stop say-

us that these drugs would not work

seems to be from my obsession with

ing this — it was a no-brainer to go

because they could not cross the

exercising , which can make them a

down this route .

blood – brain barrier , but we have

bit confusing to interpret .

Australian Doctor : So what are the risks to you ?

Professor Scolyer : Immunotherapy stimulates the body ’ s own immune

proved that is not the case before .

Australian Doctor : Could you explain the differences in your own treatment when compared with standard treatment ?

But with Georgina ’ s expertise , she can manage that and play around with my therapy to make sure I am getting as much of the drug in as possible without causing major side effects .

system to recognise the tumour ,

I recently had a bike accident , but

sending immune cells to attack it .

Professor Scolyer : Usually , you

before then , I was riding

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