Tumor regression following autologous tumor lysate-loaded dendritic cell vaccination immunotherapy: illustrative case

Abstract

Background: Despite years of research, the standard of care (SOC) treatment for grade 4 glioma has remained virtually unchanged for the last 2 decades. Autologous tumor lysate-loaded dendritic cell vaccination (DCVax-L), a novel immunotherapy, has demonstrated a significant survival benefit in a phase 3 trial.

Observations: A 34-year-old male presented with episodes of lightheadedness and was subsequently diagnosed with a large fronto-insulo-temporal tumor, likely to be high grade. He underwent an asleep craniotomy for debulking, with a residual tumor noted in the frontal lobe and amygdala. Tumor histopathology was reported as isocitrate dehydrogenase (IDH) mutant methylated grade 4 astrocytoma. He received SOC treatment, alongside a course of DCVax-L. Surveillance imaging showed cystic transformation followed by a reduction in size of the residual tumor in the frontal lobe; the residual in the amygdala had regressed entirely. The patient remained clinically well and had returned to his preoperative functionality.

Lessons: The authors report a patient with grade 4 astrocytoma who received DCVax-L treatment in addition to SOC adjuvant therapy. The pattern and extent of tumor regression are highly unusual and atypical for what is seen or expected with adjuvant SOC treatment alone. The addition of DCVax-L to SOC opens new avenues in the management of this difficult disease. https://thejns.org/doi/10.3171/CASE24112.

Keywords: DCVax-L; case report; glioblastoma; immunotherapy; treatment; tumor regression.

FIG. 1.

Axial T2-weighted (A and B) and axial T1-weighted post-gadolinium (C) images show an area of mixed T2 hyperintensity and isointensity with heterogeneous enhancement in the right fronto-insulo-temporal region, corresponding to a high-grade glioma.

FIG. 2.

Axial T2-weighted images (A and B) show a resection cavity (black arrows) at the site of the previously shown temporal component of the astrocytoma. Residual tumor is evident mainly in the frontal lobe and amygdala (white arrows).

FIG. 3.

Axial T2-weighted (A) and T1-weighted post-gadolinium (B) images show a well-defined, homogeneous signal, a non-enhancing cyst–like area in the right frontal lobe anterior to the temporal resection cavity, at the site of the previously shown area of residual tumor (white arrows). Axial T2-weighted image more inferiorly (C) the previously shown residual tumor component in the amygdala medial to the resection cavity is also no longer evident (black arrow).

FIG. 4.

Axial T2-weighted (A) and T1 post-gadolinium (B) images show a reduction in the size of the well-defined, non-enhancing cystic area in the right frontal lobe (arrows) since the previous study. Axial fluid–attenuated inversion recovery image (C) demonstrates signal suppression of the contents of this area (arrow), confirming its cystic nature. There remains no evidence of tumor recurrence.