Understanding Glioblastoma Treatment
- A Minnesota woman diagnosed with glioblastoma (GBM), the most aggressive and lethal form of primary brain tumor, landed a winning lottery ticket days after her diagnosis. After undergoing a successful surgery, she’s preparing for later stages of treatment.
- The goal of brain tumor surgery is to remove as much of the tumor as possible while preserving normal brain function. Since some tumors are located in sensitive or hard-to-reach areas of the brain, in some cases, doctors may not be able to remove all of the tumor tissue safely.
- “There’s always going to be microscopic disease left behind” after surgery, allowing the chance for the tumor to evolve further, renowned neuro-oncologist Dr. Friedman explained to SurvivorNet.
- Chemotherapy and radiation are often needed after surgery to help control this residual tumor tissue left behind.
- For some patients, the safest option might be a biopsy, which involves taking a small sample of the tumor to analyze and determine its type and specific characteristics rather than complete removal of the tumor.
A Minnesota mom diagnosed with stage 4 brain cancer, also known as glioblastoma, is preparing for an arduous journey ahead thanks to her stubborn brain tumor. However, accompanying Debbie Bury on her cancer journey is an extra $100,000, which she won with a lottery ticket she picked up shortly after her diagnosis.
“It’s not all the time you get joyful surprises on the oncology floor,” Bury’s nurse told WCCO News.
Read More“Oh gosh, you got a football. Oh my gosh, I think you won,” Bury’s daughter Melissa said.
“I just bawled. It was just amazing,” Melissa added.
WATCH: Understanding Gliomas
Given Bury’s diagnosis, the positive emotion was much appreciated by her family.
Glioblastoma (GBM) is the most aggressive and lethal form of primary brain tumor.
A glioma is a tumor originating in the central nervous system (CNS), specifically in the brain or spinal cord. A glioma originates in glial cells. Glial cells are supportive cells in the brain that protect and maintain the neurons. These types of tumors can either be benign (non-cancerous) or malignant (cancerous).
Glioblastomas present doctors with a significant challenge for treatment due to their highly invasive nature, rapid growth, and resistance to most conventional therapies.
Patient Resources for Glioma Diagnoses
Understanding Debbie’s Diagnosis
Diagnosing gliomas involves a multi-step approach that involves clinical assessment, imaging studies, histopathological examination, and molecular testing.
As patients are diagnosed, they’re observed for typical glioma symptoms. These may include:
- Headaches
- Seizures
- Cognitive or Behavior Changes
- Visual or Speech Changes and Impairments
- Loss of Body Weight and Deconditioning
- Changes in mental function, mood, or personality
- Changes in speech
- Sensory changes in hearing, smell, and sight
- Loss of balance
- Changes in your pulse and breathing rate
Patients then undergo a neurological exam that tests cranial nerve function, motor strength and coordination, sensory function, and cognitive abilities.
Next, patients undergo an MRI, which provides doctors with a visualization of the tumor.
“If you’re suspected of having a tumor on imaging and our neurosurgeons think that tumor can come out, they will take a piece of that tumor out first and confirm in the operating room and with our pathologists that, in fact, what they are looking at is a tumor,” Dr. Alexandra Miller, Director of the Neuro-Oncologist Division at NYU Langone Health, tells SurvivorNet. “And if it is, they resect it at that time. It’s not usually a two-step procedure.”
If surgery cannot be performed due to tumor location or patient-specific factors, a less invasive stereotactic biopsy can be obtained. Once the tissue sample is obtained, it’s examined under a microscope for molecular testing. At this stage, the tumor is given a grade, which determines how aggressive it is.
WATCH: Targeting Gene Mutations in Gliomas with IDH Inhibitors
- Grade I-II gliomas – These are considered low-grade and tend to grow slowly. “The grade one is a very indolent, benign tumor that can be cured with surgery alone,” Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, tells SurvivorNet.
- Grade III gliomas—These are considered high-grade and tend to grow more rapidly. They are typically classified as malignant and require more aggressive treatment, which can include surgery, radiation, and chemotherapy.
- Grade IV gliomas – These are the most aggressive gliomas, which are locally aggressive and require treatment intensification. Glioblastomas are the most common grade IV glioma, “which is by far the most well-known and feared tumor in the lay population and, quite frankly, the medical population,” Dr. Friedman explains.
WATCH: Treatment Path for Glioma Patients
What Are Treatment Options for Glioblastoma Patients?
Surgery is often the first line of treatment for patients with a brain tumor. However, other treatment options may be explored if the patient cannot withstand surgery.
The main treatment options are:
- Observation—Some benign, small, and without symptoms of gliomas or tumors located in inoperable locations can be recommended for observation.
- Surgery is often the first-line treatment for gliomas. The goal is maximal safe resection, where the largest amount of tumor is removed without causing significant neurologic deficits. For low-grade gliomas, surgery alone can sometimes be curative.
“We maximize the amount of tumor that can be removed through surgical intervention,” Dr. Friedman explains.
After surgery, pathologists examine the tumor tissue to understand its features and molecular makeup, a process part of molecular testing. This test helps doctors better understand the tumor’s genetic makeup and offers insight into an effective treatment.
One common mutation appreciated through molecular testing in gliomas is the IDH (isocitrate dehydrogenase) mutation, which can now be targeted with new treatments like Vorasidenib.
Radiation and chemotherapy are often needed after surgery because removing the tumor completely is usually not possible due to the tumor’s ability to spread into surrounding brain tissue.
- Radiation therapy uses high–energy X–rays to target and kill tumor cells. It is often used after surgery to target residual tumor cells.
- Chemotherapy – These medications kill or slow the growth of cancer cells. Chemotherapy can be used alongside radiation or following radiation and is often used in higher-grade tumors.
“There’s always going to be microscopic disease left behind even after what appears to be a gross total resection (when a surgeon removes most of the visible tumor), and the tumor can certainly evolve,” Dr. Friedman explains. Chemotherapy is used to help control this residual disease.
Together, surgery, chemotherapy, and radiation form the core standard of care for glioma patients, providing a comprehensive approach to tackling the disease from multiple angles.
WATCH: The Role of Surgery in Treating Gliomas
The Food and Drug Administration (FDA) has approved some drug treatments, including temozolomide (Temodar), to help patients with this aggressive disease. Temozolomide is a chemotherapy drug patients can take after surgery and radiation therapy.
- Targeted therapy and immunotherapy are newer treatments designed to target specific genetic mutations in the tumor or to stimulate the immune system to fight the cancer. Their role in the treatment of gliomas is continuing to evolve.
Other FDA-approved drugs for treating glioblastoma include lomustine (Gleostine), intravenous carmustine (Bicnu), carmustine wafer implants, and Avastin (bevacizumab).
Avastin is a targeted drug therapy that blocks glioblastoma cells from requesting new blood vessels that feed and allow the tumor to grow.
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