Glioma Treatment Advances: New Therapies Explained_Dr. Howard Colman_Huntsman Cancer Institute
- Treatment for gliomas varies based on tumor type and grade, typically involving a combination of surgery, radiation therapy, and chemotherapy.
- Targeted Therapies: Newer treatments, such as IDH inhibitors (vorasidenib) and BRAF/MEK inhibitors, target specific genetic mutations in gliomas, potentially offering more personalized and effective treatment options.
- Immunotherapy, including checkpoint inhibitors like nivolumab and pembrolizumab, is under investigation for gliomas.
- Clinical Trials: Specialized centers may have clinical trials testing new treatment options that can offer patients access to cutting-edge treatments.
The U.S. Food and Drug Administration (FDA) recently approved dordaviprone, the first FDA-approved systemic treatment for H3 K27M-mutant diffuse midline glioma, a rare and aggressive brain tumor primarily affecting children and young adults.
Read MoreChemotherapy for Glioma
Chemotherapy is one of the pillars of oncologic treatment. This treatment type is given through an injection or as a pill (orally) to kill or slow down the growth of cancerous cells. Today, there are several chemotherapy options available to treat different types of cancer. Additionally, choosing the chemotherapy type can rely on blood exams, a person’s overall health status, prior treatments, type of cells, localization of the tumor, potential toxicities or side effects.
Dr. Colman shares with SurvivorNet, “Chemotherapy options depend a lot on the specific type and grade of tumor. There are some newer therapies. So, for certain tumors that have certain mutations at the DNA level or alterations at the DNA level, there are targeted therapies. This is a relatively new development in brain tumors.”
In the context of glioma treatment, particularly for higher-grade tumors, the most commonly used chemotherapy drug is temozolomide (TMZ).
“The most common drug we use is a drug called temozolomide or temodar, which is an alkylating chemotherapy. Most common side effects of that are fatigue, nausea, and constipation. It can also cause drops in blood counts, which can be serious, but that doesn’t happen in a high percentage of patients,” Dr. Colman highlights.
Standard Chemotherapy Options:
Temozolomide (TMZ): Often used after surgery and radiation, TMZ is an oral chemotherapy that crosses the blood-brain barrier (a natural anatomic barrier that protects the brain), making it effective against gliomas.
It is important to note that there are also other forms of chemotherapy, as underscored by Dr. Colman. “There are other forms of chemotherapy that are used for other types of tumors. For instance, for oligodendroglioma, sometimes the primary chemotherapy is a three-drug combination called PCV, which is procarbazine, CCNU (Lomustine), and Vincristine. And each of those has their own unique toxicities. So, that is individualized to basically the diagnosis and the grade of the tumor. Again, often using this advanced testing and next-gen sequencing to help determine if the more standard radiation and chemo is the first option or a more targeted therapy.”
Procarbazine, Lomustine, and Vincristine (PCV regimen): Typically used in oligodendrogliomas with the 1p/19q co-deletion, which predicts better responses to this regimen.
Emerging and Promising Therapies
Advancements in glioma treatment have led to the development of targeted therapies and immunotherapies aimed at improving survival and reducing side effects.
Targeted Therapy
Targeted therapies focus on specific mutations in tumor cells. If your glioma has certain genetic changes, targeted drugs may be an option for you and important to discuss with your doctor.
Debating new treatment options is always exciting given its potential benefit. Dr. Colman states, “One of the big advances that just received FDA approval last year is a drug called vorasidenib. It’s in a class of drugs called IDH inhibitors that target this specific mutation. It inhibits the mutant enzyme IDH and blocks its effects”.
IDH Inhibitors: For gliomas with IDH1 or IDH2 mutations, these treatments work by targeting the cancer’s growth process, helping to slow down tumor development and help your body fight the disease.
“Another big advance has been a class of drugs called BRAF inhibitors as well as drugs called MEK inhibitors. There are a number of others, and there’s lots of work being done on the specific molecular alterations in different types of brain tumors and how those can be targeted with new therapies,” shares Dr. Colman.
BRAF Inhibitors: Used in rare gliomas with BRAF V600E mutations.
EGFR Inhibitors: Investigated for glioblastomas with EGFR alterations.
Tumor Treating Fields (TTFields): TTFields is a non-invasive therapy that uses low-intensity electrical fields to disrupt cancer cell division. It is FDA-approved for glioblastoma and used alongside chemotherapy.
Immunotherapy: Immunotherapy is a growing and potent arsenal against cancers. It has been designed to help the body’s own immune system fight cancer cells. Though still under research, another promising approach includes checkpoint inhibitors. In this class of drugs, the current drugs being studied are: nivolumab, pembrolizumab, ipilimumab, and durvalumab. These drugs are being studied because they are thought to promote tumor destruction related to the body’s immune system.
Additional Treatments: Oncolytic viruses, cell therapy, and vaccines
Clinical Trials:
Clinical trials may offer patients access to new therapies before they become widely available. Access to cutting-edge treatments may provide hope if you qualify or if the standard treatments are not effective. As a result it is important to discuss clinical trial options with your doctor.
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