Collaborating with the BTTC Network to Improve Care
The Brain Tumor Trials Collaborative (BTTC) network is comprised of over thirty institutions with expertise in neuro-oncology from across the United States with the mission to develop and perform state-of-the-art clinical trials to advance treatments for patients with brain and spine tumors. The consortium was established in 2003 and the National Cancer Institute's (NCI) Center for Cancer Research serves as the lead institution, providing administrative infrastructure, clinical database and oversight for the collaborative.
For clinical trials at the Neuro-Oncology Branch (NOB) that are part of the BTTC network, patients can participate at a center closer to their home. This paves the way for higher enrollment so doctors can complete trials that determine the benefit of the treatment being investigated at a more rapid pace. Thus far, the BTTC network has completed several clinical trials investigating the effectiveness of new and novel treatment approaches.
NOB Chief Mark Gilbert, M.D. remarked, “Over the years, the BTTC has pioneered new ways to test novel treatments, utilizing innovative clinical trial designs that both speed the completion and minimize the number of patients required to determine if the therapy is effective.” Terri Armstrong, Ph.D., deputy chief of the NOB, who pioneering the BTTC alongside Dr. Gilbert, added that, “in addition to exploring innovative treatments for the brain tumors, trials within the BTTC incorporate measures that evaluate the impact on the person by inclusion of patient reported outcomes.”
There is currently one clinical trial that is openly recruiting at 13 BTTC sites which is investigating the efficacy of pembrolizumab and the HSPPC-96 vaccine alongside temozolomide and radiation therapy for patients with newly diagnosed, unresected glioblastoma.
The NOB works closely with BTTC colleagues to oversee patients enrolled in clinical trials, provide a second opinion on their disease, and perform molecular testing. Unprecedented changes over the past few months, however, have prompted further positive collaboration between the groups.
The Neuro-Oncology Tumor Board, which takes place at the National Institutes of Health, is a bi-weekly meeting bringing together experts from neuro-oncology, neurosurgery, radiation oncology, and neuropathology to review and discuss patient cases.
The newly structured Tumor Board meetings, which are now virtual and held weekly, have been opened to integrate BTTC institutions, incentivizing doctors to present and discuss patient cases to the entire multidisciplinary team of brain and spine tumor experts at the NIH. This has become increasingly important for patients unable to travel at this time, presenting an opportunity for them to still receive comprehensive care at a remote site.
“This was a natural evolution to strengthen the care we provide to patients seeking treatment at the BTTC sites, as well as solidify our collaborative efforts with their care providers,” stated Marta Penas-Prado, M.D., an associate research physician at the NOB who has been leading the efforts to expand the tumor board in several ways.
Dr. Penas-Prado also emphasizes that this collaboration not only helps the physicians provide the best care for their patients, but also benefits the patients as well. “For those who have had a complex evolution of their disease, it is very important for all of us to put our heads together and come up with next steps for treatment that best suit the patient’s disease trajectory. This way, many experts have weighed in on a patient’s case before a care plan is initiated.”
Ukeme Ikiddeh-Barnes, a research nurse for the NOB BTTC trials, shares her thoughts on the integration as well. “It is very beneficial for both patients and physicians in the BTTC network to be able to participate in our Tumor Board so they can not only get to know our staff more intimately, but also learn more about our work, such as any upcoming trials that may be open in the BTTC network in the future. Tumor Board meetings so far have been very well attended and our BTTC colleagues have been grateful to connect with us more,” she says.
In addition to this collaborative Tumor Board, NOB and BTTC staff interact with each other through an annual BTTC/NCI-CONNECT meeting, journal club meetings, and at national conferences such as that hosted by the Society for Neuro-Oncology.
Expansion of the BTTC Network
As the need for more collaborative efforts arises to benefit patient care, the BTTC network hopes to serve as a resource for rare brain and spine tumor patients as well. The BTTC sites were invited to join the NCI-CONNECT consortium, also housed at the NOB, in 2018 to perform clinical trials focused on 12 rare brain and spine tumors. Using the BTTC multicenter infrastructure to expand rare tumor trials is valuable to this subset of patients who often lack access to treatments specific for their tumor type.
“Including rare tumor clinical trials is a big step towards improving care for patients that struggle with access to treatments that work,” says Dr. Penas-Prado. “We hope to increase referrals to our trials and utilize this expansion to test and bring treatments much faster to our rare tumor patients.”
There are several active studies at the NOB for rare brain and spine tumors, which will be expanded to the NCI-CONNECT network this year. The first of these trials, which launched in March 2020, is the retrospective tissue outcomes study that will collect and analyze tumor sample data. Another clinical trial, which is investigating whether the immunotherapy drug nivolumab is an effective treatment for rare brain and spine cancers, is currently enrolling at the NOB with plans to expand to other sites later this year.
As the networks continue to grow with more participating doctors and institutions, there will be plans for more collaborations on innovative clinical trials, making the BTTC a leader in brain and spine tumor clinical research. The hope is to continue providing the best care for trial participants and increase referrals to the many existing and upcoming investigative studies to benefit brain and spine tumor patients.