GLIOTRAIN united multiple disciplines, including tumour biology, multi-omics, drug development, clinical oncology research, computational modelling and systems biology. Our approach provided a comprehensive research strategy that went beyond the current state-of-the-art. Novel multi-omic analyses enabled simultaneous integration of gene expression, genomic instability and epigenetic data, providing a clearer insight into the cellular diversity and genetic heterogeneity present in the GBM TME. Single cell approaches revealed the complexity of biological systems. Spatial transcriptomics allowed gene expression profiles of single cells to be pinpointed to a specific location. Spatial mapping supported the identification of cellular niches and revealed location-dependent heterogeneous cell interactions.
A key result to emerge from GLIOTRAIN has been the identification of a novel subtyping approach for IDHwt GBM. Indeed the consortium highlighted the importance of establishing a precision medicine paradigm for Grade IV glioma patients in a 2020 white paper publication (‘New hints towards a precision medicine strategy for IDH wild-type glioblastoma’ White et al, Ann Oncol 2020 Dec;31(12):1679-1692). Studying IDHwt GBM subtype specific differences across the TME has revealed putative novel contexts of vulnerability. Importantly, initial results suggest a subtype specific response to immunotherapeutics. A high impact collaborative manuscript describing these data will be submitted in Q2 2022. Moreover, data generated during GLIOTRAIN have already supported multiple large scale follow-on collaborative funding initiatives to facilitate further interrogation of the biology of novel “GLIOTRAIN subtypes” and to validate the subtypes in additional datasets. Ultimately, in the coming years we aim to develop sufficient data to support a prospective Phase 2 biomarker-driven trial where GBM patients would be subtyped according to TME composition and data used to inform treatment regimens.
Overall the investigation of new biomarkers, stratification models, drug combinations and therapeutic strategies in the GBM setting undertaken during GLIOTRAIN has the potential to impact patients, clinicians and healthcare systems. The proposed biomarker-driven Phase 2 trial may lead to a new personalised treatment strategy where patients may benefit from reduced hospital time and by the avoidance of toxicities associated with ineffective therapies.
To date, 4 ESRs have successfully defended their theses. The remaining ESR projects continue beyond the end of the Action with students financially supported by their respective institutions. GLIOTRAIN has successfully trained 15 ESRs in an environment that spans translational research, medicine and computational biology, who will progress research findings towards improved patient outcomes.