Improving Care for Brain Tumor Patients

By Patrick Y. Wen, MD and David Reardon, MD

Highly malignant brain tumors called glioblastomas are the most common primary cancer of the brain; about 11,000 cases are diagnosed every year in the United States. Patrick Y. Wen, MD (Director) and David Reardon, MD, (Medical Director) of the Center for Neuro-Oncology at Dana-Farber/Brigham and Women’s Cancer Center describe the efforts to improve care for these patients.

Patrick Wen, MD
Patrick Wen, MD

Glioblastoma is one of the toughest nuts to crack in oncology; however, our team is dedicated exclusively to brain cancer patients and includes specialists in neurosurgery, radiation therapy, pathology, diagnostic imaging, and medical oncology.

Together, we are gaining tremendous insight into the biology of glioblastoma, and we’re making progress in translating these insights into strategies for improving the outcomes for our patients.

New technology has increased our ability to safely remove tumors. Our AMIGO intra-operative suite allows surgeons to operate with the aid of real-time images from MRI, PET scans, CT, X-ray, spectroscopy,  ultrasound, and other scanning instruments. It’s been invaluable in allowing us to remove the tumor while sparing normal tissue, so that patients come out of surgery with a minimal risk of setbacks, and an improved likelihood of doing well.

Radiation therapy is another critical part of our treatment. Our state-of-the-art radiation planning uses techniques such as 3-D conformal radiation, intensity modulated radio therapy, and image-guided radiotherapy to focus cell-killing radiation on tumors without overshooting and damaging normal areas.

David Reardon
David Reardon, MD

We are doing some very exciting work in immunotherapy — sensitizing the immune system to specific factors within brain tumor cells to help the body’s defenses recognize and attack the tumors. Tumors are very adaptive: they actively work to avoid attack by the immune system. We have ongoing promising clinical trials: among them, a trial of a peptide-based cancer vaccine that targets a mutant growth factor receptor present on the surface of some glioblastomas. We want to learn from the exciting results of immunotherapy in areas like melanoma and lung cancer to take these tools into the clinic over the next several months.

Glioblastomas have many genetic abnormalities that drive and sustain the tumors; we have to match the right drugs to an individual’s tumor – personalized cancer care. Dr. Wen is leading one of the first clinical trials in the country that’s testing a drug targeted to abnormal genes that drive the behavior of glioblastomas. The drug, BKM120, strikes a genetic abnormality involving the PI3K pathway and the loss of a tumor-suppressor gene, PTEN, that is present in around half of glioblastoma tumors; research studies suggest that it may help to slow or stop the growth of these tumors.

Almost all of our patients consent to have us make a genetic profile of their brain tumor, using a test called OncoMap. This is giving us a remarkable amount of information about the biology of each patient’s tumor: Our challenge is sort through this extensive amount of information and find ways to exploit it for new avenues in glioblastoma treatment.