A Neuro-Oncologist’s Three Tips For Newly Diagnosed Glioma Patients

Dr. Ospina advises patients to collaborate closely with a team of specialists, choose treatments that align with their personal needs and goals, and, above all, hold onto hope as new advances in brain tumor research continue to develop.

For instance, the recent approval of vorasidenib, a specific medication that fights an abnormal protein on the cell surface, represents a meaningful shift in how clinicians and patients can approach disease management. Beyond tumor control, this therapy introduces new possibilities for preserving quality of life and redefining long-term treatment planning. This medicine is permanently changing the glioma treatment arsenal and will change yours.

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Tip #1: Take a Multidisciplinary Approach to Treatment

“The treatment of these tumors can be very complex and multidisciplinary work is required,” Dr. Ospina tells SurvivorNet.

“And so it’s useful to be evaluated by all of the specialties that play a role in the treatment of this disease, meaning neurosurgery, neuro-oncology, and radiation oncology.”

He recomends patients review all available treatment options carefully before deciding on the approach that best suits their needs.

When it comes to treatment, Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, previously told SurvivorNet, “The first step is always the neurosurgery. How much can you take out? Is it safe to do surgery? Do you have to rely on a biopsy? Can you even do a biopsy?”

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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, with the goal of achieving 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.

After surgery, pathologists examine the tumor tissue to understand its features and molecular makeup. This added step helps doctors outline an appropriate treatment.

“We go through a very elaborate process of diagnostics, which includes looking at it under the microscope through our pathology team,” Dr. Friedman explained to SurvivorNet.

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.

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.

One year ago, radiation and chemotherapy might have been a glioma patient’s only options to continue the treatment. However, the field is leaning towards a more comfortable, potent, and strong option: vorasidenib, an FDA approved pill for the treatment of glioma with IDH1 or IDH2 gene mutations.

At present, vorasidenib is approved for patients with grade 2, IDH-mutant gliomas. However, ongoing clinical research is actively evaluating its role in additional settings, including higher-grade (grade 3) IDH-mutant gliomas and other treatment sequences. As these data mature, clinical guidelines are likely to evolve further, potentially broadening the population of patients who may benefit from early targeted intervention.

Additionally, the FDA approved Vorasidenib has been praised by Dr. Alexandra Miller, Director of the Neuro-Oncology Division at NYU Langone Health as a “huge breakthrough for people with IDH mutant tumors.” Vorasidenib is an IDH inhibitor that works by blocking the mutated enzyme, slowing tumor growth, and extending the time before disease progression. IDH mutant gliomas tend to grow more slowly and have a better prognosis than IDH wild-type gliomas.

Tip #2: Individualize Your Treatment

Dr. Ospina also stresses the need to customize treatment based on each patient’s unique needs and objectives.

He tells SurvivorNet his second tip is to “really individualize” a patient’s treatment plan.

This can be done by considering factors such as the patient’s age, personal goals, tumor location, comfort with risk, and willingness to wait, as well as evaluating options ranging from watchful waiting and starting an IDH inhibitor, to more aggressive treatments like chemotherapy and radiation.

Glioma treatment options include careful observation for small or benign tumors, performing surgery to remove as much of the tumor as safely feasible, using radiation or chemotherapy to eliminate remaining cancer cells, and exploring newer strategies such as targeted therapies or immunotherapy.

The Benefits Of A Multidisciplinary Approach To Glioma Care

Remember, it’s normal to feel overwhelmed with a diagnosis, but learning about your tumor, discussing options with your medical team, and seeking support can make the process more manageable.

Staying informed and engaging actively with your healthcare team allows for a treatment plan that is customized to your personal goals and circumstances.

Meanwhile, if you’re in need of getting help with the financial burden of a diagnosis, Dr. Nina Shah, a hematologist at the University of California San Francisco, has offered useful advice on this matter.

Paying For Cancer Treatment

RELATED: Navigating The Complexities & Limits Of Diffuse Glioma Surgery

Tip #3: Focus on Hope and Optimism

For his third recommendation, Dr. Ospina emphasized that patients should always hold onto hope, even in the face of difficult challenges.

“Even in the phase of challenging and incurable diseases, we are quickly learning more about these tumors, working hard to develop better treatments,” concluded Dr. Ospina.

RELATED: A Patient’s Perspective: Embrace Optimism and Be Your Own Hero

“And my hope is that were seeing the dawn of a new age of neuro-oncology with better treatments for patients and better long-term outcomes.”

Classifying IDH Mutant Glioma

Understanding Gliomas

There are various types of brain cancers and tumors that someone may be diagnosed with, so it’s important to understand that 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).

“Glioma is a broad term that refers to a whole range of different types of primary brain tumors,” Dr. Alexandra Miller, Director of the Neuro-Oncologist Division at NYU Langone Health, previously told SurvivorNet.

“They’re tumors that originate in the brain and very rarely spread outside the brain to other parts of the body,” Dr. Miller continued.

WATCH: Understanding Gliomas

Questions To Ask Your Doctor

If you or a loved one has received a glioma diagnosis, it can be helpful to begin discussions with your doctor by asking these important questions.

• What is the grade of my glioma?
• Have I been tested for molecular markers, and what do they mean for my treatment?
• What treatment options are available for my specific diagnosis?
• What are the possible side effects of treatment?
• How will we monitor the tumor after treatment?
• Are there clinical trials that might be beneficial for me?
• What lifestyle changes or supportive care options can help improve my quality of life?

What Exactly is a Glioma and What Does the Grade Mean for Your Treatment Plan

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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