Modern Treatments for Gliomas

Modern Treatments for Gliomas


-Hi, my name is Daniela Bota. I’m the Medical Director of Neurological Oncology at the University of California, Irvine. It is my pleasure today to talk to you about other treatments for malignant glioma patients. We are situated in the Child Comprehensive Cancer Center at UCI, where our patients are welcomed by our staff. When we talk about our brain tumor team, many times we think about neurological oncology and neurological surgery and this is where I’m going to be concentrating my talk on today. I want to introduce you to my colleague, Dr. Frank So, he is also the director of the surgical part of the brain tumor program but i think it’s equally important to remember that a brain tumor team and your oncology team is comprehensive and multidisciplinary so here i want to mention all my colleagues in neurological oncology, neurological surgery, radiation oncology neuroradiology, pathology, rehabilitation, psychiatry and psychology, nursing, social work, and dietitian. And I think it’s so important to remind everybody that’s interested in brain tumors or our brain tumor patients to our brain tumor families that all those people are working together in order to provide the best outcome for all our patients that are under our care. So what is our goal? We like to use the advanced science on which we are involved to improve patient outcomes and when we think about patient outcomes we think about two main goals: We want to increase our patient survival and we want to bring our patients on being long-term participant on their life and on their family’s. But in the same time we talked about maintaining and even improving their quality of life so keeping those things in mind let’s see how can we achieve them together patient by patient, family by family. When we talk about brain tumors and we think about what is the current standard of care it always comes on a trial of surgery, radiation, and chemotherapy. What about surgery? We know that surgery in all the forms including your surgery has progressed and advanced through the years. What we always want to remember for the surgery of patients with malignant gliomas is that the gold rule is to do no harm to the patient. The tumors have to be respected, preserved in as much quality as possible close as we can come to what we call gross total resection but that should never come to the price of deteriorating the patient condition and declining their quality of life. So this is our goal, the question is how can we achieve that goal? The things that we as medical oncologists are involved in are related to the preoperative planning of those patients in order to be able to customize their surgical plan to their individual brain structures. We cannot take simple modes and apply them to such a complicated system like the brain. What you see here are the images from one of our patients looking at the strength on his left foot. The white signal that you see is the tumor, the yellow signal that you see is where the neurons that coordinate the strength for the left foot are situated. What you can see with the studies that we can now tell this patient that the surgery will have minimal risk for the left foot strength, but it’ll also tell our colleagues or your surgeon what is the best way in which they can approach this tumor without creating neurological deficits. Another two in our armamentarium is the diffusion tensor tractography. It was the first technique we tried to find what the neurons are and to avoid the neurons that control different functions. With this technology. what we are trying to define is where are the fibers that connect different important brain structures iwhich transmit the information from one side to the other of the brain. The picture that you are seeing here looks at the transmission of the speech and the ability to understand spoken language. Very similar was what I showed you in the previous picture. knowing where the red fibers are as you can see ion the screen allows us to tell the neurosurgeons what is the area of safe surgery and what is the area on which, if it is approached, the station speech will suffer. Why all of this information? All of this information, now we’re going to go and will be used during surgery and the technologies that are going to be used during surgery. This most important function of those technologies will be not to harm the fibers and the center’s that make us who we are which guarantees our quality of life and our function. It does not matter in the end if patients survive longer if their survival is not associated with a better quality of life. I would like now to move in the future of chemotherapy after the surgery and radiation is completed and there are few things that we are involved in at University of California, Irvine. We’ve been involved in those projects for years. Some of them right now are coming to fruition and they’re transforming themselves on FDA-approved treatments. Others are in different stages of research, either in our laboratories – cells and animal models – or they are right now applied to patients in clinical trials. So the first step that we have to discuss again is personalized medicine. In the years before, we used to categorize all the tumors in a few categories based on how they looked under a microscope. Recently, we learned that every patient’s tumor has its own genetic makeup, which also allows us to determine the response to different chemotherapies, which will vary patient by patient. The modern clinical trials for new tumor-target drugs, one to take into account the differences in the genetic structure of the tumor, making sure that the patients that get placed in a certain drug category and receive certain treatments are the patience to stand the most chance to respond to certain treatments. Another project that we’ve been involved in for many years is the development of alternating electrical field therapy, which is now called Optune. This therapy was approved by the Food and Drug Administration in October 2015 for newly diagnosed glioblastoma patients. The impact of this therapy on patient survival was important, was meaningful, was five months and more and more patients lived two years or longer. This is a technology in which we have been involved since 2011, when the initial approval for the current glioblastoma was obtained. We are one of the highest volume centers in the nation and very recently, we participated in writing the guidelines, teaching other doctors what is the best way to use this therapy for the treatment of patients with newly diagnosed, as well as recurrent glioblastoma. The new things coming on the treatment for glioblastoma right now are related to immunotherapy. We know that teaching the patient’s immune system to fight cancer is achieving great successes right now in multiple cancer types, including gland cancer and melanoma. Clinical trials in major immuno therapy approaches are right now taking place over the nation. We have positioned ourselves as being one of the major immunotherapy hubs for these type of tumors and we are right now very focused on developing our new strain of immunotherapy to be offered to the patients that do not have other means of fighting their tumors. The next therapy that we want to keep in the radar is the viral therapy. The important part about viral therapy is that it can specifically target the cancer cell and not to attack the normal cells of the brain or the other organs of the patient’s body. There are different types of viral therapies. Some of them are delivering suicide genes, which will allow the cells that are infected with this virus – remember what we talked before, the cancer cells – to be attacked and killed either by the virus or by the immune system that comes and fight the cells that are carrying the viruses. So I think in the end, I would like to talk to you about what success looks like. For a scientist and a physician, many times success looks like – you could see on this slide – we started as a patient that was having a large tumor on the brain, we treated at large and aggressive tumor through a combination of treatments, including surgery, radiation, chemotherapy, new clinical trials, and now our patient is doing well and is in remission. But, it seems for me, success looks like this – looks like the team of physicians, the patient, and their family working together to achieve better outcomes for patients with brain tumors. Thank you so much for giving me the time to present to you new therapies and your approaches for the treatment of malignant gliomas. If you have more questions, or you want more information about the work that is taking place in our program, please visit our web page or call our clinic.

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6 thoughts on “Modern Treatments for Gliomas”

  • On 4th August,2018 after CT scan my father got a tumor on his head. The size of the tumor is 5.4 * 4.2 * 4.0 cm. Operation was done on August 10, 2018. Cancer was detected after surgery. Tumors were sent for testing in two places. But the most strange thing is that there are two different types of reports. Coming to Astrocytoma grade-2, Glioblastoma grade-4 coming to another. What do I trust now?So now my father's IMRT + TMZ is running. My question to everyone am i able to start treatment at the right time? could my dad get rid of this diseases?

  • Would u plz tell glioblastoma multiform at satge of 63 what's the chance of survival of patience account to available medical treatment in India existing