Understanding Glioblastomas
- Two of the nation’s leading brain cancer experts, Dr. Henry S. Friedman and Dr. Kyle M. Walsh, are refuting implied claims that artificial turf containing PFAS “forever chemicals” helped lead to several Phillies baseball players’ glioblastoma (GBM) diagnoses.
- Dr. Friedman and Dr. Walsh disputed assertions radiation emitted from radar guns to detect the speed of baseballs and chemicals contained in artificial turf contribute to GBM. They said radiation and chemical amounts are too low to penetrate a glioblastoma brain tumor’s brain barrier to cause a significant impact.
- Glioblastoma (GBM) is an aggressive form of brain cancer that “grows and spreads very quickly,” according to the National Cancer Institute. The average survival rate is 15 months with treatment and less than six if left untreated.
- Symptoms often associated with glioblastoma may include seizures, headaches, changes in speech, and difficulty balancing.
- Surgery often cannot remove all of the glioblastoma because of the way the tumor burrows into the brain. However, treatment options exist for glioblastoma, offering patients and their families much-needed hope.
A pair of the nation’s leading brain cancer experts want to set the record straight regarding assertions AstroTurf causes the cancerous brain tumor glioblastoma. Their powerful rebuke of news reports suggesting several “Phillies” baseball players died of glioblastoma because of PFAS (polyfluoroalkyl substances) chemicals used in artificial turf is “light on scientific facts and heavy on alarmism.”
Dr. Henry S. Friedman, a noted neuro-oncologist who helps lead The Preston Robert Tisch Brain Tumor Center at Duke Cancer Institute, is one of the experts criticizing the news report by the Philadelphia Inquirer. Friedman has spent years trying to develop new approaches to battling malignant brain tumors.
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It said, “There isn’t sufficient data to fully understand the potential risks of inhaling forever chemicals, or coming in repeated contact with them…Thus far, there have been no studies linking forever chemicals to brain cancer.”
Dr. Friedman and Dr. Walsh noted in a guest editorial in “The Cancer Letter” that “GBM incidence is highest in men, in non-Hispanic white individuals” between 50 and 75. They began addressing assertions such as radar guns to determine the speed of baseballs thrown, which do not produce enough radiation to cause harm.
“Radar guns operate in the same electromagnetic band as motion detectors, with frequencies below the visible spectrum and well below that of ionizing radiation (e.g., X-rays),” Dr. Friedman and Walsh said.
The experts then disputed implied claims that PFAS exposure would substantially impact glioblastoma diagnosis. They said there is “little biologic plausibility for a connection.”
“While noting that environmental health concerns around PFAS exposure are based on valid scientific research, we also cited research showing that compounds like PFAS have poor penetrance across the blood-brain barrier and reach the brain at levels 1,000-fold lower than other organs,” Dr. Friedman and Dr. Walsh said.
While pushing for additional research, Dr. Friedman and Dr. Walsh suggested more sensitivity be practiced for the families of the players impacted by glioblastoma and others still battling the cancerous brain tumor, which has no known cure.
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PFAS and Its Link to Cancer Cases
According to the National Cancer Institute, “Higher kidney cancer incidence and mortality have been observed among individuals with high PFOA (perfluorooctanoic acid) exposures from employment in a PFAS (polyfluoroalkyl substance) producing chemical plant or residence in the surrounding community with contaminated drinking water.”
The Centers for Disease Control and Prevention said scientists are still learning the health effects of exposure to different PFAS. Other PFAS health risks may include:
- Infant birth weight impacts
- Increase the risk of high blood pressure or pre-eclampsia in pregnant women.
- Changes in liver enzymes
- Decrease vaccine response in children
- Increase cholesterol levels
Living With Glioblastoma
Glioblastoma is considered a central nervous system (CNS) tumor.
According to the National Cancer Institute, the average survival rate is 15 months with treatment and less than six if left untreated. While there is a five-year survival rate averaging 6 percent, those individuals will never be cancer-free and must continue receiving radiation and chemotherapy for the rest of their lives.
Former Senators John McCain and Ted Kennedy were two high-profile figures who battled a glioblastoma brain tumor.
What makes glioblastomas so difficult to treat and manage is their cells are heterogeneous, meaning that each one must be individually targeted to slow tumor growth. Surgery also cannot remove all the cancer because of how the tumor burrows into the brain. This means the tumor starts to grow again immediately after surgery.
Glioblastoma risk factors can include:
- Prior radiation exposure
- Gender: men are more likely to get glioblastoma than women
- Age: people 50 years or older
- Certain genetic syndromes, including neurofibromatosis, tuberous sclerosis, von Hippel-Lindau disease
According to MD Anderson Cancer Center, symptoms for glioblastoma can vary depending on the area of the brain where the tumor begins and spreads and its growth rate. But common symptoms of glioblastoma can include:
- Headaches
- Seizures
- 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
Options to Treat Glioblastoma
Although glioblastomas are difficult to treat, the Food and Drug Administration’s (FDA) approval of the drug temozolomide (Temodar) was a massive breakthrough in helping patients with this aggressive disease.
Temozolomide is a chemotherapy drug patients can take after surgery and radiation therapy.
Dr. Daniel Wahl, professor of radiation and oncology at the University of Michigan, explains Temozolomide is an oral drug that ” slows down tumor growth.”
“Patients with GBM have effective treatment options, there are four of them: surgery, radiation, chemotherapy, and tumor targeting fields. These are electric fields that we can use to treat these cancers,” Dr. Wahl said.
Other FDA-approved drugs created to treat glioblastoma include lomustine (Gleostine), intravenous carmustine (Bicnu), carmustine wafer implants, and Avastin (bevacizumab).
Avastin is a targeted drug therapy that blocks glioblastoma cells from sending requests for new blood vessels that feed and allow the tumor to grow.
“Outcomes for these patients are still suboptimal. What I tell my patients is that we have these effective treatments, but what they do is they delay the time to when this tumor comes back. Only in exceptional circumstances would we ever talk about getting rid of one of these cancers a few,” Dr. Wahl said.
WATCH: Using electric sources to improve glioblastoma treatment.
Fortunately, research is ongoing to improve the prognosis for people battling glioblastoma. One area of promise is tumor-treating fields, which can help extend patients’ lives by two years on average, giving them hope.
Optune, the brand name for the tumor-treating fields delivery device, was launched in 2011 and approved by the FDA in 2015. It is a wearable and portable device for glioblastoma treatment for adult patients aged 22 years or older.
“There’s been a very exciting development of tumor treating fields, which are electrical fields that have been applied to the brain,” Dr. Suriya Jeyapalan, a neurologist at Tufts Medical Center, previously told Survivor Net.
TTFields use low-intensity electric fields to disrupt the cell division process, making it harder for cancerous cells to multiply.
Despite the hope of Optune, not all cancer experts agree with its approach, including Dr. Friedman.
“Although the National Comprehensive Cancer Network (NCCN) recognizes Optune within its guidelines as a therapy to be considered for glioblastoma, many people don’t believe it adds value. At Duke, for example, we don’t consider it a mainstay of therapy,” Dr. Friedman said.
Dr. Friedman’s Modified Poliovirus GBM Treatment
Dr. Friedman and his colleagues at Duke have been researching a new therapy that combines a modified poliovirus and immunotherapy. The modified poliovirus is used to treat glioblastoma brain tumors. Immunotherapy is a cancer treatment that uses the body’s immune system to combat cancer cells from within.
Dr. Friedman shared the therapy works by injecting the modified poliovirus directly into the tumor through a catheter. It lyses the tumor. Tumor lysis occurs when cancer cells fall apart and flood the bloodstream faster than the body can rid itself of them due to cancer treatment such as chemotherapy.
“[The process] causes the tumor cells to basically break up,” Dr. Friedman previously explained to SurvivorNet.
“Now we’re injecting poliovirus into the wall of the crater of the tumor because that’s where most tumor cells reside. We’re also injecting it into the lymph nodes on the same side the tumor is located in the body,” Dr. Friedman explained of the modified approach.
“With repetitive dosing of poliovirus immunotherapy, hopefully, we can boost the 5-year survival rate beyond 20 percent,” Dr. Friedman said.
Questions for Your Doctor
If you have been diagnosed with glioblastoma, here are some questions you may consider asking your doctor:
- What stage is my brain cancer?
- What are the treatment options for my brain cancer?
- What are the risks and benefits of the recommended treatment?
- What are the side effects of the recommended treatment?
- How long will it take to recover from treatment, and will I be able to return to work and normal activities?
- What’s the likelihood that insurance will cover the recommended treatment?
- Am I a good candidate for temozolomide, Optune, or clinical trials?
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