Peter Fecci

Overview:

As the Director of both the Brain Tumor Immunotherapy Program and the Center for Brain and Spine Metastasis at Duke University, I focus our programmatic interests on the design, optimization, and monitoring of immune-based treatment platforms for patients with intracranial tumors, whether primary or metastatic. Within this broad scope, however, my own group looks more specifically at limitations to immunotherapeutic success, with a particular focus on understanding and reversing T cell dysfunction in patients with glioblastoma (GBM) and brain metastases. We employ a systematic approach to categorizing T cell dysfunction (Woroniecka et al, Clin Cancer Res 2018 Aug 15;24(16):3792-3802), and whereas our earlier work addressed concerns for regulatory T cell-induced tolerance, we now heavily study T cell ignorance and exhaustion, as well. Regarding the former, we recently published the novel phenomenon of S1P1-mediated bone marrow T cell sequestration in patients with intracranial tumors (Chongsathidkiet et al, Nat Medicine 2018 Sep;24(9):1459-1468). Regarding the latter, we have likewise recently identified and characterized exhaustion as a significant limitation to T-cell function within GBM (Woroniecka et al, Clin Cancer Res 2018 Sep 1;24(17):4175-4186). I very much look to collaboratively integrate our approaches with others investigating innovative treatment options. I continue my focus on combining strategies for reversing T cell deficits with current and novel immune-based platforms as a means of deriving and improving rational and precise anti-tumor therapies. It is my sincerest desire to forge a career focused on co-operative, multi-disciplinary, organized brain tumor therapy. Ultimately, my goal is to help coordinate the efforts of a streamlined and effective center for brain tumor research and clinical care. I hope to play some role in ushering in a period where the science and treatment arms of brain tumor therapy suffer no disjoint, but instead represent the convergent efforts of researchers, neuro-oncologists, medical oncologists, radiation oncologists, biomedical engineers, and neurosurgeons alike. I hope to see such synergy become standard of care.

Positions:

Associate Professor of Neurosurgery

Neurosurgery
School of Medicine

Assistant Research Professor in Immunology

Immunology
School of Medicine

Associate Professor in Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2007

Duke University School of Medicine

Ph.D. 2007

Duke University

Internship, General Surgery

Massachusetts General Hospital

Residency, Neurosurgery

Massachusetts General Hospital

Postdoctoral Fellow

Dana Farber Cancer Institute

Instructor, Neurosurgery

Massachusetts General Hospital

Grants:

Laser Ablation using Robotic Neuroblate System (LAANTERN)

Administered By
Neurosurgery
Role
Principal Investigator
Start Date
End Date

NINDS Research Education Programs for Residents and Fellows in Neurosurgery

Administered By
Neurosurgery
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

LITT and Short Course Radiation for Patients with GBM Requiring Standard Treatment Alternatives (LASR)

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Directed Chemotherapy Delivery for Leptomeningeal Metastases

Administered By
Neurosurgery
Role
Co Investigator
Start Date
End Date

Validation of Novel Therapeutic Approach for Leptomeningeal Metastases

Administered By
Neurosurgery
Role
Co Investigator
Start Date
End Date

Publications:

CAR T cells and checkpoint inhibition for the treatment of glioblastoma.

Introduction: Glioblastoma (GBM) is a highly aggressive brain tumor and is one of the most lethal human cancers. Chimeric antigen receptor (CAR) T cell therapy has markedly improved survival in previously incurable disease; however, this vanguard treatment still faces challenges in GBM. Likewise, checkpoint blockade therapies have not enjoyed the same victories against GBM. As it becomes increasingly evident that a mono-therapeutic approach is unlikely to provide anti-tumor efficacy, there evolves a critical need for combined treatment strategies.Areas covered: This review highlights the clinical successes observed with CAR T cell therapy as well the current efforts to overcome its perceived limitations. The review also explores employed combinations of CAR T cell approaches with immune checkpoint blockade strategies, which aim to potentiate immunotherapeutic benefits while restricting the impact of tumor heterogeneity and T cell exhaustion.Expert opinion: Barriers such as tumor heterogeneity and T cell exhaustion have exposed the weaknesses of various mono-immunotherapeutic approaches to GBM, including CAR T cell and checkpoint blockade strategies. Combining these potentially complementary strategies, however, may proffer a rational means of mitigating these barriers and advancing therapeutic successes against GBM and other solid tumors.
Authors
Shen, SH; Woroniecka, K; Barbour, AB; Fecci, PE; Sanchez-Perez, L; Sampson, JH
MLA Citation
Shen, Steven H., et al. “CAR T cells and checkpoint inhibition for the treatment of glioblastoma.Expert Opin Biol Ther, vol. 20, no. 6, June 2020, pp. 579–91. Pubmed, doi:10.1080/14712598.2020.1727436.
URI
https://scholars.duke.edu/individual/pub1431231
PMID
32027536
Source
pubmed
Published In
Expert Opin Biol Ther
Volume
20
Published Date
Start Page
579
End Page
591
DOI
10.1080/14712598.2020.1727436

A review of glioblastoma immunotherapy.

INTRODUCTION: Glioblastoma is a very aggressive cancer with dismal prognosis despite standard of care including surgical resection, radiation therapy, and chemotherapy. There is interest in applying immunotherapy to glioblastoma as this modality has demonstrated remarkable improvements in the management of several solid tumors including melanoma, renal cell carcinoma, and non-small cell lung cancer. This review aims to provide an overview of the current state of glioblastoma immunotherapy. METHODS: Literature search was performed on PubMed between 1961 and 2020. RESULTS: Initial clinical trials of checkpoint inhibitors and vaccine therapy for glioblastoma have largely been disappointing for both primary and recurrent glioblastoma. This failure has been attributed to glioblastoma's highly immunosuppressive environment and multiple mechanisms of therapy resistance including high tumor heterogeneity, low mutational burden, systemic immunosuppression, and local immune dysfunction. CONCLUSIONS: Current clinical trials are exploring combination therapy and novel treatment strategies beyond immune checkpoint therapies and vaccine therapy such as CAR T cells. There is also an effort to establish synergy between immunotherapy and current standard of care. Furthermore, recent advances in personalized neoantigen vaccines suggest a shift towards personalized, patient-specific GBM treatment.
Authors
Medikonda, R; Dunn, G; Rahman, M; Fecci, P; Lim, M
MLA Citation
Medikonda, Ravi, et al. “A review of glioblastoma immunotherapy.J Neurooncol, Apr. 2020. Pubmed, doi:10.1007/s11060-020-03448-1.
URI
https://scholars.duke.edu/individual/pub1437926
PMID
32253714
Source
pubmed
Published In
J Neurooncol
Published Date
DOI
10.1007/s11060-020-03448-1

Renal artery aneurysm.

Authors
Hahn, B; Fecci, A; Jacobs, C
MLA Citation
Hahn, Barry, et al. “Renal artery aneurysm.J Emerg Med, vol. 38, no. 5, June 2010, pp. 654–55. Pubmed, doi:10.1016/j.jemermed.2007.11.030.
URI
https://scholars.duke.edu/individual/pub1433625
PMID
18462907
Source
pubmed
Published In
Journal of Emergency Medicine
Volume
38
Published Date
Start Page
654
End Page
655
DOI
10.1016/j.jemermed.2007.11.030

Current multidisciplinary management of brain metastases.

Brain metastasis (BM), the most common adult brain tumor, develops in 20% to 40% of patients with late-stage cancer and traditionally are associated with a poor prognosis. The management of patients with BM has become increasingly complex because of new and emerging systemic therapies and advancements in radiation oncology and neurosurgery. Current therapies include stereotactic radiosurgery, whole-brain radiation therapy, surgical resection, laser-interstitial thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and immune-checkpoint inhibitors. Determining the optimal treatment for a specific patient has become increasingly individualized, emphasizing the need for multidisciplinary discussions of patients with BM. Recognizing and addressing the sequelae of BMs and their treatment while maintaining quality of life and neurocognition is especially important because survival for patients with BMs has improved. The authors present current and emerging treatment options for patients with BM and suggest approaches for managing sequelae and disease recurrence.
Authors
MLA Citation
Moravan, Michael J., et al. “Current multidisciplinary management of brain metastases.Cancer, vol. 126, no. 7, Apr. 2020, pp. 1390–406. Pubmed, doi:10.1002/cncr.32714.
URI
https://scholars.duke.edu/individual/pub1428070
PMID
31971613
Source
pubmed
Published In
Cancer
Volume
126
Published Date
Start Page
1390
End Page
1406
DOI
10.1002/cncr.32714

Laser Ablation of Abnormal Neurological Tissue Using Robotic Neuroblate System (LAANTERN): Procedural Safety and Hospitalization.

BACKGROUND: Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN; Monteris Medical) multi-institutional, international prospective observational registry. OBJECTIVE: To determine the procedural safety of SLA for intracranial lesions. METHODS: Prospective procedural safety and hospitalization data from the first 100 treated LAANTERN patients was collected and analyzed. RESULTS: Mean age and baseline Karnofsky Performance Status (KPS) were 51(± 17) yr and 83(± 15), respectively. In total, 81.2% of patients had undergone prior surgical or radiation treatment. Most patients had a single lesion (79%) ablated through 1 burr hole (1.2 ± 0.7 per patient), immediately following a lesion biopsy. In total, >90% of the lesion was ablated in 72% of treated lesions. Average total procedural time was 188.2 ± 69.6 min, and average blood loss was 17.7 ± 55.6 ccs. The average length of intensive care unit (ICU) and hospital stays before discharge were 38.1 ± 62.7 h and 61.1 ± 87.2 h, respectively. There were 5 adverse events (AEs) attributable to SLA (5/100; 5%). After the procedure, 84.8% of patients were discharged home. There was 1 mortality within 30 d of the procedure (1/100; 1%), which was not attributable to SLA. CONCLUSION: SLA is a safe, minimally invasive procedure with favorable postprocedural ICU and hospital utilization profiles.
Authors
Rennert, RC; Khan, U; Bartek, J; Tatter, SB; Field, M; Toyota, B; Fecci, PE; Judy, K; Mohammadi, AM; Landazuri, P; Sloan, AE; Kim, AH; Leuthardt, EC; Chen, CC
MLA Citation
Rennert, Robert C., et al. “Laser Ablation of Abnormal Neurological Tissue Using Robotic Neuroblate System (LAANTERN): Procedural Safety and Hospitalization.Neurosurgery, vol. 86, no. 4, Apr. 2020, pp. 538–47. Pubmed, doi:10.1093/neuros/nyz141.
URI
https://scholars.duke.edu/individual/pub1435966
PMID
31076762
Source
pubmed
Published In
Neurosurgery
Volume
86
Published Date
Start Page
538
End Page
547
DOI
10.1093/neuros/nyz141

Research Areas:

Blood-Brain Barrier
Brain metastasis
Cancer
Glioma
Glioma, Subependymal
Immunotherapy
Immunotherapy, Active
T cells
T cells--Effect of drugs on
T cells--Receptors
Translational Medical Research