If you or a loved one has been diagnosed with a brain tumor or other brain disorder, the experts at Roswell Park Comprehensive Cancer Center are here for you. Our Neuro-Oncology team will work with you to create a personalized treatment plan that meets both your needs and preferences. Whether you need a second opinion or are seeking treatment, we can help.
In this segment, Robert Fenstermaker, MD, discusses Glioblastoma, brain tumors and the treatment options available at Roswell Park Comprehensive Cancer Center.
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Understanding Glioblastoma and Brain Tumors
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Learn more about Robert Fenstermaker, MD
Robert Fenstermaker, MD
Robert Fenstermaker, MD is the Chair, Department of Neurosurgery at Roswell Park Comprehensive Cancer Center.Learn more about Robert Fenstermaker, MD
Transcription:
Understanding Glioblastoma and Brain Tumors
Bill Klaproth (Host): With the recent news of Senator John McCain being diagnosed with glioblastoma, a form of brain cancer, many are wondering what that is. Here to tell us more is, Dr. Robert Fenstermaker, chair of the Department of Neurosurgery at Roswell Park Comprehensive Cancer Center. Dr. Fenstermaker, thank you for your time today. So, let's start at the beginning, what is glioblastoma?
Dr. Robert Fenstermaker (Guest): Glioblastoma is the most common and aggressive brain cancer. It occurs in about 15,000 people in the United States per year, and is the subject of a lot of focus by neurosurgeons and neurooncologists.
Bill: So, what makes glioblastoma so difficult to treat?
Dr. Fenstermaker: Well it's particularly difficult because it tends to infiltrate or insinuate itself into the surrounding normal tissue, and because that tissues the brain, that’s exquisitely sensitive to manipulation and to the effects of the tumor, so that a surgeon can go in and remove the tumor that they see on an MRI scan, and afterwards the scan looks like there's no tumor, but in fact, there is microscopic levels of disease left behind, and they're in normal tissue, and so, it's very hard to remove them, unfortunately.
Bill: So, what are the typical treatment options for glioblastoma?
Dr. Fenstermaker: At that point, most patients undergo radiation therapy and chemotherapy, usually with a drug called temozolomide, and the purpose of that is to treat the tissue around the surgical resection cavity, and kill remaining tumor cells, and the treatment is variably effective, more effective in some patients than others. And so, it's the subject of most research these days, is trying to kill those last few tumor cells that remain behind. Unfortunately, in most cases, though, that isn’t effective, and eventually the tumor comes back within about an inch of where the surgery left off.
Bill: And are there typical symptoms that someone would experience with glioblastoma.
Dr. Fenstermaker: Yes, it can vary because the brain has functions localized in different areas. A lot depends on where the tumor arises, if it occurs close to the heart of the brain that controls motor function, then a patient may develop weakness on one side of their body or an obstruction to vision in one field of vision. Tumors can also present with headaches, in some cases, although that's not the most common. I think most people think brain tumors always cause headaches, but that's not always the case. And certainly, seizures or epilepsy can be an initial symptom, that brings a person to the emergency room, and instead of a stroke, a tumor’s is discovered in many cases. And this is an aggressive form of cancer.
Bill: And this is an aggressive form of cancer, and what is the general prognosis?
Dr. Fenstermaker: From the studies of glioblastoma, we know that the current standard therapy consisting of surgery, radiation therapy and chemotherapy gives a median or we’ll say an average survival of about 15 months, but depending upon different molecular factors, and the patient's age and so forth patients, can live longer, and in fact some patients will live five and 10 years, but that's the exception rather than the rule, long term survival is not common with the disease.
Bill: And, Dr. Fenstermaker, can you tell us about the Sur Vax M vaccine that's being developed by Roswell Park Cancer Institute.
Dr. Fenstermaker: Sure, a lot of folks are interested in immunotherapy for cancer, and there’s some drugs on the market for treating other types of cancers. It used to be thought that immune cells from our immune system wouldn't penetrate the brain and wouldn't be effective against tumors, but that that view is changing, the brain and brain tumors are subject to the immune system, and so, Sur Vax M, is one form of immune therapy that's designed to stimulate the patient's immune system to trigger a reaction against a protein that's present only in the tumor cells called survivor. Hence the name Sur Vax, and by stimulating the patient's immune system to produce cells that kill the tumor. We're hopeful that that will positively impact those cells that remain after surgery and prolong a patient's survival with this disease.
Bill: And who would be a good candidate then for Sur Vax M?
Dr. Fenstermaker: Well, Sur Vax M is still in clinical trials, so it's not available, apart from those specific indications, but generally for the clinical trial, patients have newly diagnosed glioblastoma, the tumors have to have been resected, so that we have minimum amount of disease, in which case immune therapy is expected to be more effective, particularly this kind of immune therapy. And we're not currently studying patients that have recurrent disease. It's really in the upfront setting where we can add it to standard therapy to try and really get in at the very beginning of the disease when the patient's immune system is healthy, and we can stimulate it really well with a vaccine.
Bill: And what results are you seeing so far in the clinical trials?
Dr. Fenstermaker: In our Phase one clinical trial, we saw a number of responders and long-term survivors, and those results are published and out there. We're currently in the midst of Phase two, and the results are promising. I can't give you specific numbers at this point, but we're encouraged enough that we expect that this will go on to a Phase three trial, and hopefully someday it'll be in the armamentarium against this disease, along with the other the other methods we have currently.
Bill: So, the Phase three trial is up next then?
Dr. Fenstermaker: That's the plan, yes, to get a drug approved of this sort and able to be used in a widespread manner, we need a phase three trial.
Bill: And is there anything else we should know about glioblastoma?
Dr. Fenstermaker: I think it's important that people understand that while it is a tough disease to treat, there are a lot of people working on different approaches to it, and things are getting better, although it is slower than we would like, but I'm optimistic that in the coming few years, we'll have much better treatments than we've had in the past. And that molecular therapies and immunotherapy are going to be an opening against this disease.
Bill: And that is good news indeed, and it seems to me that if someone is feeling the symptoms that you talked about earlier, that the sooner they see a doctor the better, which doesn't give this cancer a chance to spread out into the brain like you were talking about.
Dr. Fenstermaker: It's important to try and detect these things as early as possible, so that treatment can begin before neurologic problems develop. It's always easier to prevent them than to recover from them once occurred.
Bill: Right, well, Dr. Fenstermaker, thank you so much for your time today, we appreciate it. For more information visit, RoswellPark.org, that's, RoswellPark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth, thanks for listening.
Understanding Glioblastoma and Brain Tumors
Bill Klaproth (Host): With the recent news of Senator John McCain being diagnosed with glioblastoma, a form of brain cancer, many are wondering what that is. Here to tell us more is, Dr. Robert Fenstermaker, chair of the Department of Neurosurgery at Roswell Park Comprehensive Cancer Center. Dr. Fenstermaker, thank you for your time today. So, let's start at the beginning, what is glioblastoma?
Dr. Robert Fenstermaker (Guest): Glioblastoma is the most common and aggressive brain cancer. It occurs in about 15,000 people in the United States per year, and is the subject of a lot of focus by neurosurgeons and neurooncologists.
Bill: So, what makes glioblastoma so difficult to treat?
Dr. Fenstermaker: Well it's particularly difficult because it tends to infiltrate or insinuate itself into the surrounding normal tissue, and because that tissues the brain, that’s exquisitely sensitive to manipulation and to the effects of the tumor, so that a surgeon can go in and remove the tumor that they see on an MRI scan, and afterwards the scan looks like there's no tumor, but in fact, there is microscopic levels of disease left behind, and they're in normal tissue, and so, it's very hard to remove them, unfortunately.
Bill: So, what are the typical treatment options for glioblastoma?
Dr. Fenstermaker: At that point, most patients undergo radiation therapy and chemotherapy, usually with a drug called temozolomide, and the purpose of that is to treat the tissue around the surgical resection cavity, and kill remaining tumor cells, and the treatment is variably effective, more effective in some patients than others. And so, it's the subject of most research these days, is trying to kill those last few tumor cells that remain behind. Unfortunately, in most cases, though, that isn’t effective, and eventually the tumor comes back within about an inch of where the surgery left off.
Bill: And are there typical symptoms that someone would experience with glioblastoma.
Dr. Fenstermaker: Yes, it can vary because the brain has functions localized in different areas. A lot depends on where the tumor arises, if it occurs close to the heart of the brain that controls motor function, then a patient may develop weakness on one side of their body or an obstruction to vision in one field of vision. Tumors can also present with headaches, in some cases, although that's not the most common. I think most people think brain tumors always cause headaches, but that's not always the case. And certainly, seizures or epilepsy can be an initial symptom, that brings a person to the emergency room, and instead of a stroke, a tumor’s is discovered in many cases. And this is an aggressive form of cancer.
Bill: And this is an aggressive form of cancer, and what is the general prognosis?
Dr. Fenstermaker: From the studies of glioblastoma, we know that the current standard therapy consisting of surgery, radiation therapy and chemotherapy gives a median or we’ll say an average survival of about 15 months, but depending upon different molecular factors, and the patient's age and so forth patients, can live longer, and in fact some patients will live five and 10 years, but that's the exception rather than the rule, long term survival is not common with the disease.
Bill: And, Dr. Fenstermaker, can you tell us about the Sur Vax M vaccine that's being developed by Roswell Park Cancer Institute.
Dr. Fenstermaker: Sure, a lot of folks are interested in immunotherapy for cancer, and there’s some drugs on the market for treating other types of cancers. It used to be thought that immune cells from our immune system wouldn't penetrate the brain and wouldn't be effective against tumors, but that that view is changing, the brain and brain tumors are subject to the immune system, and so, Sur Vax M, is one form of immune therapy that's designed to stimulate the patient's immune system to trigger a reaction against a protein that's present only in the tumor cells called survivor. Hence the name Sur Vax, and by stimulating the patient's immune system to produce cells that kill the tumor. We're hopeful that that will positively impact those cells that remain after surgery and prolong a patient's survival with this disease.
Bill: And who would be a good candidate then for Sur Vax M?
Dr. Fenstermaker: Well, Sur Vax M is still in clinical trials, so it's not available, apart from those specific indications, but generally for the clinical trial, patients have newly diagnosed glioblastoma, the tumors have to have been resected, so that we have minimum amount of disease, in which case immune therapy is expected to be more effective, particularly this kind of immune therapy. And we're not currently studying patients that have recurrent disease. It's really in the upfront setting where we can add it to standard therapy to try and really get in at the very beginning of the disease when the patient's immune system is healthy, and we can stimulate it really well with a vaccine.
Bill: And what results are you seeing so far in the clinical trials?
Dr. Fenstermaker: In our Phase one clinical trial, we saw a number of responders and long-term survivors, and those results are published and out there. We're currently in the midst of Phase two, and the results are promising. I can't give you specific numbers at this point, but we're encouraged enough that we expect that this will go on to a Phase three trial, and hopefully someday it'll be in the armamentarium against this disease, along with the other the other methods we have currently.
Bill: So, the Phase three trial is up next then?
Dr. Fenstermaker: That's the plan, yes, to get a drug approved of this sort and able to be used in a widespread manner, we need a phase three trial.
Bill: And is there anything else we should know about glioblastoma?
Dr. Fenstermaker: I think it's important that people understand that while it is a tough disease to treat, there are a lot of people working on different approaches to it, and things are getting better, although it is slower than we would like, but I'm optimistic that in the coming few years, we'll have much better treatments than we've had in the past. And that molecular therapies and immunotherapy are going to be an opening against this disease.
Bill: And that is good news indeed, and it seems to me that if someone is feeling the symptoms that you talked about earlier, that the sooner they see a doctor the better, which doesn't give this cancer a chance to spread out into the brain like you were talking about.
Dr. Fenstermaker: It's important to try and detect these things as early as possible, so that treatment can begin before neurologic problems develop. It's always easier to prevent them than to recover from them once occurred.
Bill: Right, well, Dr. Fenstermaker, thank you so much for your time today, we appreciate it. For more information visit, RoswellPark.org, that's, RoswellPark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth, thanks for listening.