Hope Comes in Many Forms for Patients With Cancer

For many with glioblastoma, there’s no clear path after standard therapy, but scientists are exploring an array of new options.
BY TARA HAELLE
PUBLISHED: JULY 21, 2017
“It is frustrating not having more tools to try to attack and make sure it doesn’t come back, and I think that’s what the doctors feel, too — there’s a limited number of tools they can use,” he says. 

Indeed, despite big strides in therapies for many other cancers, advances for glioblastoma have not kept up. The long-term prognosis is typically bleak, with five-year survival rates below 10 percent. The standard of care has evolved only marginally in recent decades. Radiation quadruples survival from three months to 12 months, and Temodar adds a few more months, which improved median survival from 12 months to nearly 15 months when it came out.

Patients also often take Avastin (bevacizumab), a drug that interferes with the growth of blood vessels that feed tumors. This reduces swelling and lengthens time to tumor progression. While the drug doesn’t add to overall survival in this population across the board, it has been associated with better longevity in certain subgroups. 

“In three decades, after hundreds and hundreds of clinical trials and untold millions of dollars of both government and private-sector research dollars, we made an advance of three to five months of median survival,” says Howard Fine, M.D., the founding director of the Brain Tumor Center at Weill Cornell Medical Center in New York City. 

Meanwhile, “We’ve seen the prognosis shift dramatically in other cancers in a very short period of time,” says Andrew Chi, M.D., Ph.D., director of neuro-oncology at NYU Langone’s Perlmutter Cancer Center and co-director of Langone’s Brain Tumor Center. “With the amount of discovery that we’re doing today, (that progress) is really going at an exponential rate.” 

But the lag in progress in treating glioblastoma is certainly not for lack of trying — and researchers have only redoubled their efforts to find new therapeutic options. Few cancers have as many diverse experimental therapies in clinical trials as glioblastoma. 

THE TRICKIEST TUMORS 

The challenges associated with glioblastoma start with its name. 

“A term like glioblastoma is actually very nonspecific and nonaccurate,” Chi says. “It’s made up of different diseases, and if you look at them from a genetic perspective, some have a relatively good prognosis and others have a very poor prognosis from the outset.” 

More than 2,000 to 3,000 glioblastoma tumors have been sequenced by the research community to date and "almost none of them are totally alike,” Fine says. He expects the terminology to change over the next decade, with clinicians referring to these tumors, and basing their treatments, more on their genetic classifications than on older pathological terminology such as "astrocytomas" or "oligodendrogliomas." 



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