Amanda Wilde (Host): For patients with a brain tumor diagnosis, it's important to know that there is effective, individualized medical care and support focused on you. VCU Massey Comprehensive Cancer Center offers the full continuum of care, from prevention to detection to treatment and survivorship. Dr. Mariza Daras is Chief of Neuro-Oncology at VCU Massey Comprehensive Cancer Center. And just ahead, she'll talk about brain tumors, treatment options, and innovations in neuro-oncology. This is Healthy with VCU Health. I'm Amanda Wilde. Welcome to the podcast, Dr. Daras. Thank you for being here.

Dr Mariza Daras: Thank you for having me.

Host: You just joined Massey in September 2023 to lead Massey's Neuro-Oncology Program, which treats patients with brain tumors. Can you talk a little bit about your background and what drew you to Massey?

Dr Mariza Daras: So, I'm from the East Coast. I grew up in New York. Professionally, I received my medical degree from Columbia University. I completed my neurology residency at Duke, then did my fellowship at Memorial Sloan Kettering Cancer Center in New York. I was an attending there for a number of years. So before coming to Massey, I was at University of California, San Francisco with their Brain Tumor Center, and I helped grow a multidisciplinary program for the care of patients with brain metastases. And then, this position at VCU presented itself to lead the Division of Neuro-Oncology. It was a really exciting position. Massey recently achieved Comprehensive Cancer Center status from the NCI, and it recognizes Massey's excellent work in cancer research, training, and community engagement. And this opportunity to join Massey really at this point in time to build upon that success was really exciting to me. And with leadership here at VCU, we really share a vision of growing a neuro-oncology program that offers a comprehensive model of care, a multidisciplinary care similar to what I was doing at UCSF, to really support patients and their loved ones throughout their journey with brain cancer. So, that was really just something that excited me and, ultimately, I accepted the position.

Host: I've read on your webpage that you provide a level of expertise found only at the top 4% of cancer centers across the country. What does that mean?

Dr Mariza Daras: So, I think that really speaks to Massey's excellence and really what enabled it to get comprehensive cancer center status. It offers clinical trials. It leverages strong community partnerships. It really provides holistic care for every part of a patient's life as they travel through their journey with cancer. And our focus in neuro-oncology is really not only to provide improved therapies, but to improve the quality of life of our patients as well.

Host: Not a huge part of the population has brain tumors. And yet, when you look at the numbers, it's like a lot of people. So, how common is a brain tumor diagnosis?

Dr Mariza Daras: It depends on how you think of it. But malignant tumors of the brain or of the spinal cord, really occurs in less than 1% of people. So, that's about, you know, 25,000 malignant tumors of the brain or spinal cord are diagnosed a year in the United States. That's a small proportion of people. They're impacted pretty significantly by their disease. These numbers would be much higher if you include benign non-cancerous tumors such as meningiomas that can still have pretty significant consequences for patients. And then when you incorporate brain metastases, patients are living much longer with cancer and brain metastases occur in 20-30% of patients with systemic cancer. So, that's a large proportion of people.

Host: Meaning people develop brain cancer as a secondary to original cancer.

Dr Mariza Daras: Yeah, that's right.

Host: What types of brain tumors do you treat? There's a whole spectrum, isn't there?

Dr Mariza Daras: So, I treat people who have a diagnosis of a primary brain tumor or spinal cord tumor. This includes glioblastoma, low-grade gliomas such as astrocytomas and oligodendrogliomas. I treat patients with meningiomas or appendomomas. And then, I also treat people with a diagnosis of cancer that has metastasized to the brain, the spinal fluid, or the spinal cord from other areas of the body. For example, patients that have breast or lung cancer or melanoma that has spread to different parts of the nervous system.

Host: So, I want to talk about treatment options. But before getting to that, are there any signs or symptoms people should be aware of that could indicate the need to see a specialist such as yourself?

Dr Mariza Daras: So, symptoms can really vary based on the type of tumor and the part of the brain or the nervous system being affected. Sometimes patients present with headaches or seizures. They can present with personality or behavioral changes, changes in vision or hearing, weakness or numbness that affects one side of the body. So, anytime anyone is experiencing abrupt changes in memory, processing, language, or any of those symptoms that I discussed above, they should really speak to their primary care doctor or, in more emergent settings, go to the emergency room. And really, the MRI is the best tool we have to be able to detect if symptoms are related to a brain tumor. And if there is a concern for a tumor based on imaging, really having specialized care at a comprehensive cancer center can really provide important resources.

Host: That's the only way to go, I think, because you want the best and the most specialized care you can get. How does a patient find their way to Massey to see you if they have had that diagnosis?

Dr Mariza Daras: So, patients come to us through really a variety of channels. They can be referred from a provider within VCU if they're seeing somebody here or elsewhere in the community. Patients that are looking for a second opinion or searching on their own sometimes reach out to us directly to speak to our team about treatment. So, any of those ways are appropriate and we can help.

Host: And you recommend patients see a board-certified neuro-oncology specialist rather than a general oncologist for brain tumors.

Dr Mariza Daras: Brain tumor patients really require specialized care, especially since the brain and spinal cord are connected. The nervous system in general is such a unique organ. Patients that come to see us here, they really have individually focused plans that are developed by a multidisciplinary team. These teams include a neuro oncologist such as myself, a really experienced neurosurgeon, radiation oncologist, and then we have a number of supportive services as well.

We offer patients access to clinical trials with novel therapies that it can extend or improve their quality of life. We routinely do next generation sequencing to really understand how a tumor may respond to treatment. And then, we have robust program that focuses on patients and caregivers quality of life.

Host: So, all those things surrounding treatment. Let's talk about treatment. What treatment options are currently available for the patients you see?

Dr Mariza Daras: Treatment options for patients with brain tumors really depend on the size, the type, the grade, the location of the tumor. So, all of those things play a role. These therapies include surgery, radiation, chemotherapy, targeted therapies, and of course clinical trials. And many times what we're doing is a combination of all of those different modalities really.

Host: Right. That's the interdisciplinary approach you referred to.

Dr Mariza Daras: That's right. That's what really I think helps provide an excellent level of care. It's bringing all of the expertise of these different providers for the care of a single patient.

Host: Absolutely. Are you seeing innovations in the field of neuro-oncology at this time? I know Massey's sort of on the cutting edge of innovations in the field. What are you most excited about?

Dr Mariza Daras: There's a significant amount of research currently happening to try and improve the outcomes of patients with brain tumors. There are clinical trials that are exploring targeted therapies as we learn about kind of the genetic drivers of these tumors, for example, EGFR inhibitors with improved penetration through the blood brain barrier. There are a number of trials looking at immunomodulatory therapies, therapies that impact the immune system to help fight the tumor. And these approaches include viruses, so oncolytic viruses that infect and help treat the tumor. Often these are injected directly into the tumor. There are CAR T-cell therapies that use a person's own immune cells. We modify those to target the tumor and then, of course, there are vaccine therapy studies as well. And then, there are some studies that are looking at the disruption of the blood-brain barrier. It can be hard for chemotherapies and for drugs to actually get to the area of the tumor, and there are devices using ultrasound, for example, to help improve drug penetration. So, all of these are really beginning to offer novel and exciting potential therapies for this group of patients.

Host: All those things we hear about, like targeted therapy, are happening in this field as well. So, brain tumor patients at Massey can expect specialized in holistic care. As we wrap up here, is there anything else you'd like listeners to know?

Dr Mariza Daras: I think most important thing is that, you know, being diagnosed with a brain tumor spinal cord tumor can really be incredibly frightening for both a patient and their family, and can really have life-changing consequences. We at VCU really recognize that and do everything we can to help support a patient and their loved ones through their journey of brain cancer, so they can really live a full life in spite of their diagnosis. And then, this includes treatment to target the tumor, but also programs to help support them, their quality of life, their cognitive function, and also help support distress that can be related to these tumors.

Host: Thank you so much for all this information, doctor. A brain tumor diagnosis deserves an individually focused plan developed by a multidisciplinary team of medical professionals, which is exactly what you offer, and I'm just looking forward to see what innovations you make in the future.

Dr Mariza Daras: Thank you very much. It's my pleasure to speak with you today and we really are excited to help patients, and really serve the community as best we can.

Host: That was Dr. Mariza Daras, Chief of Neuro-Oncology at VCU Massey Comprehensive Cancer Center. To schedule an appointment or learn more about brain tumor care at Massey, please call 804-828-8228 or visit masseycancercenter.org. To listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. I'm Amanda Wilde. Thanks for listening.