Glioblastoma-What It Is And How It's Treated

by Jane Ashley

The nation is saddened to learn about the death of John McCain. WhatNexters are particularly saddened because he died from glioblastoma (often referred to as GBM), an aggressive form of brain cancer.

John Mc Cain

We can be certain that John McCain would want his experience with the glioblastoma to be a catalyst for more research leading to more effective treatments.

What is glioblastoma?

Glioblastoma is a form of tumor that forms from astrocytes, the “star-shaped” cells that make up the connective tissue of the brain. These tumors reproduce rapidly and are supplied by a vast number of blood vessels.

They are aggressive and spread rapidly to adjoining brain tissue. The American Association of Neurological Surgeons reports that GBM occurs most often in the frontal and temporal lobes of the brain. These two lobes of our brain are responsible for sense reception, problem-solving, emotional responses, our personality and ability to communicate. Because the areas affected are so critical, this destructive cancer often results in death within the first 15 months of diagnosis.

Symptoms of glioblastoma.

Symptoms may occur suddenly and advance quickly. Symptoms include:
• Blurred or double vision
• Headaches, often severe
• Nausea and vomiting
• Personality or mood changes
• Seizures

Blurred Visio

Glioblastoma generally occurs in adults over 40, but in rare cases, it may strike babies, children and young adults. Physicians use CT scans and brain MRI scans to detect the presence of a brain tumor. A neurosurgeon performs a biopsy to determine the type and grade.

Treatments for glioblastoma.

Treatments always aim to maintain quality of life. They include:

• Surgery. The gold standard of treatment is surgery. Because this type of tumor is located in the “normal” part of the brain, surgeons remove as much as the tumor as possible while trying to spare normal functions including motor skills, walking and speaking … to maintain a patient’s quality of life. Intraoperative mapping, sometimes called “awake brain surgery,” may be used to help the surgeon remove as much of the tumor as possible while protecting language and other key functions.
• Radiation. Once a patient recovers from surgery, standard external beam radiation therapy is directed to the tumor site and margins. This radiation damages both normal and cancerous cells, but most normal cells repair the damage within a day. Ten to thirty daily treatments (given daily five days a week) helps provide longer survival times after surgery.
• Chemotherapy. The oral chemotherapy drug temozolomide is usually given at the same time as a patient receives radiation. After radiation, this chemo is usually given for 6 to 12 cycles, a cycle being five days of chemo pills followed by 23 days of rest. Unfortunately, this chemotherapy only works in about 20 percent of the patients.
• Other therapies. Occasionally, an electrical field (called TTF) can disrupt the cancerous cells’ ability to reproduce. Avastin, which blocks the formation of new blood vessels to a cancerous tumor, may help some patients.

Duke Health Doctor

Finding hope for the future

Clinical trials investigating immunotherapy, gene therapy, highly focused radiation and chemo used in conjunction with vaccines show promise. But this hope is tempered by the fact that median survival rates have only improved by three months over the past thirty years.
Duke Cancer Institute is conducting one of the most promising research projects. They are using a genetically altered poliovirus vaccine that is directly infused into the brain tumor through a surgically-implanted catheter. This modified virus targets tumor cells and triggers an immune response.

This investigation has been an 18-year partnership between Duke, the National Cancer Institute and the U.S. Food and Drug Administration.

This Phase 1 clinical trial demonstrated that considerably improved survival times may be possible. Three-year survival time was found in 21 percent of patients compared to just 4 percent with current treatment recommendations. Phase 2 clinical trials utilizing the poliovirus vaccine combined with the chemotherapy drug lomustine for patients who have experienced recurrences. Duke is now enrolling pediatric patients with brain tumors. These researchers will soon be offering a similar trial using the poliovirus vaccine for select breast and melanoma patients.

We, as WhatNexters, can only hope that Duke’s work in the field of glioblastoma will continue and help bring hope for those who receive a diagnosis of glioblastoma.

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