Blood marker changes may help track glioblastoma progression

Changes in blood levels of an enzyme called lactate dehydrogenase (LDH) may offer clues about disease activity in glioblastoma, an aggressive type of glioma, according to a new analysis.

Alpheus Medical, which is developing an experimental glioblastoma treatment called Porphyrin Metabolite Activation (PoMA), presented the new findings at the European Society for Medical Oncology (ESMO) Congress 2026 in Madrid, Spain.

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LDH levels may offer clues about disease progression

LDH is an enzyme found in most of the body’s cells. Blood tests measuring LDH can help detect tissue damage. In an exploratory analysis, researchers examined whether changes in LDH levels over time were linked to disease activity during treatment for glioblastoma. The analysis included 15 people with recurrent glioblastoma whose tumors were classified as MGMT-unmethylated. All had received PoMA treatment in an early clinical study.

“Cancer biomarkers are often interpreted as snapshots in time, and imaging of glioblastoma is challenging because treatment-related imaging changes can mimic disease progression. We wanted to understand whether the trajectory of LDH over time could provide complementary information,” Vijay Agarwal, MD, CEO of Alpheus Medical, said in a company press release.

All patients whose condition worsened, based on researchers’ clinical assessments, showed sustained increases in blood LDH levels during treatment. An initial large increase or repeated rises in LDH appeared to provide more information about disease status than smaller, isolated changes. By contrast, patients without evidence of clinical progression generally had stable or declining LDH levels.

“The ESMO findings suggest that sustained increases in LDH tracked with clinical deterioration, while patients without evidence of clinical progression generally showed stable or declining LDH,” Agarwal said.

According to Alpheus, patients whose brain scans suggested possible disease progression generally had stable LDH levels. The company said tracking changes in LDH over time may provide additional information when brain scans are difficult to interpret.

“We now plan to evaluate this prospectively in a larger group of patients to better understand how [changes in LDH levels over time] relate to disease progression,” Agarwal said.

How experimental PoMA treatment works

Alpheus’ experimental glioblastoma treatment PoMA begins with an oral medication called 5-aminolevulinic acid (5-ALA). Doctors already use 5-ALA to help identify glioblastoma tissue during surgery. In the body, 5-ALA is converted into a substance called protoporphyrin IX (PpIX), which builds up in glioblastoma cells.

After PpIX builds up in glioblastoma cells, a device developed by Alpheus delivers low-intensity ultrasound to the brain. The ultrasound is designed to activate PpIX, producing harmful molecules called reactive oxygen species (ROS) that can damage or kill cancer cells.

Alpheus is sponsoring a Phase 2 trial (NCT07225621) testing PoMA in people with newly diagnosed glioblastoma. All participants receive standard chemotherapy along with either PoMA treatment or a placebo medication and sham ultrasound procedure. The trial’s main goal is to assess whether PoMA delays disease progression. The Phase 2 trial is currently recruiting at sites in the U.S.

Alpheus is also conducting a Phase 1 study (NCT07862647) testing PoMA in people with butterfly glioblastoma, a form of the disease that spreads across the brain’s two hemispheres. That trial is recruiting at a site in New York.