From the Guidelines
For patients with brain tumors, treatment should be individualized based on tumor type, size, location, and the patient's overall health, with a focus on maximizing quality of life and minimizing morbidity and mortality. When considering treatment options, it is essential to weigh the potential benefits and risks of each approach.
- For patients with a favorable prognosis, treatment options may include surgery, radiation therapy, and chemotherapy, as outlined in the ASCO guideline update 1.
- The choice of treatment depends on various factors, including the tumor's size, location, and symptoms, as well as the patient's overall health and preferences.
- In some cases, systemic therapy may be considered, particularly for patients with HER2-positive metastatic breast cancer and brain metastases, where the HER2CLIMB regimen of tucatinib plus capecitabine plus trastuzumab may be offered 1.
- Regular follow-up with a neuro-oncologist is crucial to monitor treatment response and manage side effects, as well as to adjust the treatment plan as needed to optimize outcomes.
- It is also important to note that brain tumors can have a significant impact on quality of life, and therefore, treatment should prioritize not only extending survival but also minimizing symptoms and improving functional outcomes.
- The need for increased development of therapeutics for treating brain tumors is urgent, particularly for glioblastoma, which is one of the most common and aggressive types of brain tumors, with a median survival of only 14-16 months despite current standard treatments 1.
From the FDA Drug Label
14 CLINICAL STUDIES
- 1 Newly Diagnosed Glioblastoma Multiforme Five hundred and seventy-three patients were randomized to receive either temozolomide (TMZ)+Radiotherapy (RT) (n=287) or RT alone (n=286). The addition of concomitant and maintenance temozolomide to radiotherapy in the treatment of patients with newly diagnosed GBM showed a statistically significant improvement in overall survival compared to radiotherapy alone
- Temozolomide is used to treat brain tumors, specifically glioblastoma multiforme.
- The drug has shown a statistically significant improvement in overall survival when used in combination with radiotherapy compared to radiotherapy alone.
- Key findings from the study include:
- Median survival increased by 2.5 months in the temozolomide arm.
- Hazard ratio (HR) for overall survival was 0.63 (95% CI for HR=0.52 to 0.75) with a log-rank P<0.0001 in favor of the temozolomide arm.
- The overall tumor response rate (CR + PR) was 22% (12/54 patients) and the complete response rate was 9% (5/54 patients) in the refractory anaplastic astrocytoma population 2.
From the Research
Brain Tumour Treatment
- The current mainstay of treatment for glioblastoma involves maximally safe surgical resection followed by radiotherapy and concomitant temozolomide chemotherapy, as stated in 3.
- Aggressive surgical resection followed by standard chemotherapy and radiation therapy can improve outcomes for patients with glioblastoma multiforme (GBM), according to 4.
- Maximal safe resection is the first intervention for management of glioblastoma, offering tissue for diagnosis, decompression of the brain, cytoreduction, and has been associated with prolonged survival, as discussed in 5.
Surgical Management
- Intraoperative MRI (iMRI) is a recent surgical advancement that enables maximal surgical resection of glioblastoma lesions, with an average extent of resection of 94% in one study, as reported in 4.
- Techniques such as intraoperative MRI, 5-ALA, and neuronavigation can help achieve a maximal safe resection, as mentioned in 6.
- Advances in surgical techniques allow for minimally invasive approaches, including the use of tubular retractors, endoscopes, and laser interstitial thermal therapy, as described in 6.
Diagnostic Accuracy
- MRI-guided stereotactic biopsy specimen can accurately represent the grade of the larger glioma mass, sufficiently guiding subsequent therapy, as found in 7.
- The diagnostic accuracy of biopsy can be affected by factors such as enhancement on MR, with MR-nonenhancing lesions yielding more consistent histology with subsequent craniotomy, as noted in 7.