While it is logical that 5-ALA by itself had a positive effect on survival for one or even two years, the combination of early DCVax-L treatment and 5-ALA assisted surgery may have been a devastating blow to the GBM tumor in that the vaccine very often completely prevented the remaining relatively fewer tumor cells to regrow.
If the last 108 patients did not contain a higher proportion of Treatment patients than the earlier enrolled 223 patients, the superior survival of those 108 of whom 42 survived past 36 months is even more remarkable but could perhaps be attributed to the much more frequent use of 5-ALA during surgery.
With the trial's average 2.34:1 ratio of Treatment:Control, we would have among the last 108 patients about 32 Control and 76 Treatment patients. We would expect about 45% of those 76 Treatment patients or 34 to carry the more longevity friendly methylated GBM tumors. It stands to reason that the overwhelming majority of the 42 post 36 months survivors originating from the last 108 patients were members of that group of 34 patients with the methylated GBM tumors.
It is also quite possible that in this trial, the majority of Treatment patients with the methylated GBM who benefited from 5-ALA assisted surgery, not only reached 36 months alive but became 5(+) years survivors as well.
If so, a cure for that methylated GBM group is in site. Perhaps something like an addition of Keytruda will yield the touchdown.
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