Melanie:  Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're giving a clinical update on low-grade glioma. Joining me is Dr. Jessica Templer. She's an Assistant Professor of Neurology in Epilepsy and clinical Neurophysiology at Northwestern Medicine. Dr. Templer, it's a pleasure to have you join us today. Tell us a little bit about the new low-grade glioma program at Northwestern Medicine. How did this come about?

DR Jessica Templer: Well, thank you very much for having me. Really, what we're trying to do is we're developing a program that's designed to provide expert collaborative care for patients with low-grade gliomas over the course of their lifetime. And it really came about with discussions with myself and our neurooncologist, Dr. Karan Dixit, and one of our neurosurgeons, Dr. Matthew Tate, in discussions of how we can really improve care for this patient population.

A lot of this requires multidisciplinary care where we're each not working independently in our own silos, but actually communicating about our thoughts about the patient, what treatment plans are, how the patient's doing. And we decided the best idea would be to have a home for these patients where we see them on a routine basis. And we see them as a group of physicians talking about their plan and discussing next steps in their care.

And the program itself, often these patients are young, healthy people in their 20s to 40s. They've never needed to go to the doctor, never needed a medication and, suddenly, they have a new diagnosis that can be life-altering. And our goal at the program is to be a partner with these patients to help them understand their disease, offer them support medically, surgically and psychologically. And currently, there are no similar programs within the United States of which I am aware of that offers this type of care to patients with low-grade gliomas. And our goal is to improve that care.

Melanie: That was an excellent summary. Thank you so much, Dr. Templer. So as an epileptologist, what's your role in the low-grade glioma program?

DR Jessica Templer: As an epileptologist, I specialize in the treatment of seizures and nearly all patients with low-grade gliomas present with a seizure as their first symptom leading to the discovery of their tumor. If a patient has not had surgery for a suspected low-grade glioma, I will work closely with their neurosurgeon to collaborate on the best surgical approach to render the patient seizure-free after surgery.

However, many patients commonly have seizures despite surgery and their seizures may require multiple antiseizure medications. My goal is to help my patients live their lives without seizures impairing their day-to-day activities while also minimizing any side effects from their medications. And that's often a very delicate balance. And I really try to develop a close relationship to my patients, understand their perspective and goals along with their treating physicians so that I can provide the best care possible.

Melanie: So tell us some of the latest and most exciting treatments for low-grade glioma? How is the new knowledge influencing the changing practice for the management of this condition?

DR Jessica Templer: Well, there are a lot of outstanding questions that are yet to be answered for patients with low-grade gliomas. And we know that we want to work towards longer survival and ultimately a cure for this disease. We're also focused on improving the quality of life for patients with low-grade gliomas.

And there's a lot of data that we still need to collect and understand these patients on a longitudinal basis. So not just understanding how they're doing clinically in their time of initial presentation, coming up with a treatment plan and then monitoring them over time, but instead monitoring them and checking in on them frequently from a neurocognitive standpoint, from a seizure standpoint and, overall, just to make sure that we are providing the best care possible.

As part of this program, what we're asking all patients to allow us to do is to systematically collect the data from the testing they're undergoing on a routine clinical basis. While this seems to be a relatively straightforward first step, this population is heterogeneous in the literature and a data repository is just the beginning of that systemic approach to the disease. And so we're working on collecting that data. And ideally, we'll collect that data, move forward on providing better care for these patients.

Melanie: Well, then tell us what Northwestern Medicine is doing to improve the quality of life for patients with low-grade glioma. And why is this so important?

DR Jessica Templer: As part of the Northwestern low-grade glioma program, we realized that our patients are not just patients with low-grade gliomas, rather they're people that are working in living with the diagnosis. We've created this program so we can help our patients cope with all aspects of the disease. Our goal is to create a home for our patients so they can look to us to help them in managing all aspects of the diagnosis and the impacts it can have on their life.

When patients have their primary treating physicians at outside institutions, we may be able to provide resources that are not available at their local hospitals that can really help them with these quality of life issues. We have support groups, we have neuropsychologists and a dedicated social worker that can work in tandem with their local providers.

Melanie: So tell us about some research that's in the pipeline for low-grade glioma and seizures. What's exciting in the field right now?

DR Jessica Templer: As I mentioned, there are a lot of outstanding questions that are yet to be answered and our goal is to move forward in answering those questions with a systematic approach. So beyond the repository, from an epilepsy standpoint, there is no guiding algorithm to aid physicians with an anti-seizure medication regimen for patients with low-grade gliomas. That is in part due to the poor acquisition of data regarding seizures in this population.

My goal is to monitor seizure response to anti-seizure medications in tandem with their imaging data, neurocognitive data and treatment response. And this will allow me as well as other physicians in the future to base our decisions regarding seizure medications and scientifically based evidence and this has not yet been done for this patient population.

In addition, we are looking to better understand the timing to intervene and change management in these patients to optimize outcome. This type of tumor will inevitably convert to a malignant tumor. Although the timing when to take the patient back to surgery, when to consider additional chemotherapy is yet to be determined. And it is only with a review of the data that's collected in a systematic way, including neurocognitive data and advanced imaging techniques that we will best be able to answer these questions.

Melanie: So tell us what makes Northwestern Medicine's program different? What would you like other providers to know about what you're doing there at Northwestern Medicine and why it's so important that they refer?

DR Jessica Templer: Our ultimate goal, as I mentioned, is really to provide exceptional care to patients with low-grade gliomas. And we can only do that with a better understanding of how this disease progresses, when we should intervene and when is the best time to change their treatment plans. We are looking to collaborate with physicians outside of Northwestern, and really just become a part of their treating team for their patients. As such, any patient in the program will come to our multidisciplinary clinic once every six months or more frequently, if necessary. And we will provide a summary of data for the patient as well as their treating physician.

So one example of this is that we know that the rate of growth in tumor size increases when the patient's tumor has converted to a higher grade tumor. We will review all images, obtain any relevant metrics for all patients, and then provide their physician with key data points, including the rate of growth to aid in their treatment decisions.

We are happy to transition any patient's care to our clinic. However, in many cases, we will likely be enrolling patients in the research protocol and providing useful summaries to treating providers on a semi-annual basis.

Melanie: Is there anything else you'd like to share, Dr. Templer, as we wrap up?

DR Jessica Templer: I think ultimately, as the providers that are seeing patients with low-grade gliomas, we understand how devastating this diagnosis can be. And we hope that we can provide not only the clinical care that patients need, collaborating with their treating providers, but also provide the emotional and psychological support for these patients that they deserve as they're struggling and coping with this disease.

Melanie: Such an important point. What a great way to end. Thank you so much, Dr. Templer, for joining us today. To refer your patient or for more information, please visit our website at nm.org to get connected with one of our providers.

That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to download, subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.