I cannot argue against your response. It is a good one, makes a lot of sense and comes from a committed professional.
You say that you have spoken with oncologists in your network. What do they know about DC VAX L/D? Do they think the PFS end point has been achieved? If not, does it really matter? Even if PFS eventing were not significantly improved over SOC but progression were slowed as a result of the vaccine unfolding its effect over time, wouldn't this be a good result? Do you think the SAP would address this aspect? How about OS separation between Tx and crossover/non-crossover arms? Does it matter? If little separation, isn't that a good thing because it would show some efficacy wrt "late" vaccinations?
On what groups does DC VAX L show efficacy in your/their opinion? Methylated? Methylated what? Pro-neural, MES, classical? Dr. Liau has remarked upon the especial efficacy of DC VAX L wrt to MES. Is that methylated MES or all MES?
Have you seen the chart in the intro to the iHub MB that delineates Methylated and un-Methylated and further breaks down M+ and M- into molecular sub-groups. M+ , according to the chart, is composed JUST of pro-neural. However, in earlier studies, Prins and Liau found that the vaccine has little to no effect on pro-neural. Further, in prior clinical studies, Prins and Liau found that the vaccine is particularly efficacious wrt to mesenchymal(M+). However, in the chart, MES, along with classical and neural, is in the un-Methylated group where DC VAX L efficacy is considerably less than in the M+ group. However, Prins and Liau found that MES responded much better to DC VAX L because it was more "immunogenic".
According to this chart, then, it appears that DC VAX L works very well on pro-neural because it is M+ and may also work very well on MES even though it is in the M- grouping. If this is so, then DC VAX L appears to work rather well on a majority of nGBM. M+(pro-neural according to the chart) comprises almost 45% of the categorised groups(N=293 because 38 initially were not categorised). In addition MES according to the literature comprises between 25%~40+% of all nGBM. M+ and MES would cover over 60% at least of the nGBM population.
Look, IwasDriver, I am no expert and I am open to persuasion. Can you and/or your oncologist colleagues address the foregoing in some depth? I have read some of the scientific literature but not being an expert and not doing this for a living, I get confused. Your thoughts would be greatly appreciated by me and I am certain, by a lot of other MB denizens. BTW, I raised these questions in considerably greater depth with Alton Boynton and never received any response despite extensive follow-up. Ditto with Innes. Ditto with Rago. I also raised these issues with another professional who occasionally posts who could not really respond. Gave an honest answer: "I don't know". Best regards.
Umibe
