We have advanced the development of novel, personalized vaccines designed to target each patient’s individual brain tumor and empower the patient’s own immune system to fight their specific tumor. In particular, we are focused on the management of glioblastomas, the most prevalent and aggressive malignant brain cancer. Glioblastomas present a formidable treatment challenge, as they are characterized by their complexity, intrinsic resistance to treatments, and scarce therapeutic options currently available. Montefiore Einstein remains at the forefront of precision medicine and cancer immunotherapy, forging new paths in the treatment of brain tumors through translational research and clinical trials to secure better outcomes and improved quality of life for our patients.

Led by Adilia Hormigo, MD, PhD, as principal investigator, we are conducting a single center, phase 1 trial using precision medicine to study the safety, tolerability and immunogenicity of a personalized genomic vaccine—a mutation-derived tumor antigen vaccine—administered in combination with tumor treating fields and standard care treatment for patients with newly diagnosed glioblastoma. The personalized vaccine is prepared in the laboratory with several peptides based on each patient's own tumor sequence. Investigators hope that the study vaccine may help stimulate an effective immune response  targeting patient-specific tumor cells that express a particular antigen. The vaccine is administered following the radiation and chemotherapy portion of the treatment, during the maintenance phase of temozolomide, an alkylating agent, in conjunction with tumor treating fields. 

We are exploring the synergies between immune checkpoint inhibitors and other targeted therapies to unlock new avenues of treatment, identifying genetic, molecular, and cellular signatures that predict how a tumor will respond to or resist immunotherapy. We also seek to understand how the dynamics between cancer and auto-immunity can be leveraged for therapeutic gain. 

In 2023, we published the results of a phase I trial of VEGF-A inhibition combined with PD-L1 blockade for recurrent glioblastoma. We found that avelumab, a human IgG1 monoclonal antibody immune checkpoint inhibitor directed against PD-L1, administered alone within a week after laser interstitial thermal therapy, or in combination with VEGF-A inhibition with bevacizumab (a monoclonal anti-vascular endothelial growth factor antibody), for recurrent glioblastoma is well tolerated and safe. Significant immune modulation of cytokines and immune cells by bevacizumab, which may enhance the effect of immune checkpoint inhibition, was also found.

We are also committed to finding reliable biomarkers that can predict tumor responses and resistance to treatment, facilitating personalized treatment strategies. This past year, we published our research on using EGFR amplification, identified by molecular sequencing as associated with worse survival rates, to stratify recurrent glioblastoma treated with immune checkpoint inhibitors. This could potentially be used as a biomarker of immune checkpoint inhibitor resistance, with further validation from prospective studies.

We also continue to spearhead targeted clinical trials, providing patients access to emerging treatment that is otherwise unavailable. Led by Adilia Hormigo, MD, PhD, and Allison Martin, MD, Montefiore Einstein is one of only three sites in New York State to participate in the ACTION study—a global, multicenter, randomized, placebo-controlled Phase 3 study assessing the investigational drug ONC201 for the treatment of patients with newly diagnosed H3 K27M-mutant diffuse glioma, a rare subset of glioblastoma, following completion of standard frontline radiotherapy. 

We’re ranked in the top one percent of all U.S. hospitals for cancer care and among the highest performing centers in the nation for neurology and neurosurgery, according to U.S. News & World Report, and are among the elite one percent NCI-designated Comprehensive Cancer Centers in the U.S.

Clinical Trial: NCT03223103
Clinical Trial: NCT05580562