I believe that it's clear that when the vaccine is given scans have shown the tumor to be larger on many occasions. The problem is the scans can't differentiate between true progression and pseudoprogression. I recently emailed DI and he assured me that it's still the case, scans alone don't differentiate. I really can't say if they currently make that determination, or if they watch what happens to determine if the patient is getting better, or not.
What we do know is more people are living long term. Perhaps when we get the Journal we'll learn whether many who survived the longest were people who appeared to progress rapidly, or not. It's clear that progression can't be a way to judge the trial in this cancer, we really don't know if other cancers will react this way, or not. I would think that needle biopsy ought to indicate whether a tumor is largely dead mass, but several samples may be required to really know. I don't know how difficult and/or painful it is to do needle biopsies on GBM patients.
I hope the Journal will answer these, and many other questions, but don't know that it will. I would assume that all who passed on in the trial were autopsied, if so we'd learn more about those who passed on, and no doubt we'd continue to track the survivors. Perhaps in time other tests will differentiate between progression and pseudoprogression, if that was possible perhaps progression, which should shorten the duration of a trial, will again be considered viable, but for now the real proof is people living longer, and ultimately that's the goal anyway.
Gary
