Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole and joining me today is Dr. Rajiv Magge. He's an Associate Professor of Neurology at Weill Cornell Medical College-Cornell University, and a neuro-oncologist at the Weill Cornell Brain Tumor Center. He's here to talk to us today about the latest in research and treatments for brain tumors.

Dr. Magge, it's a pleasure to have you join us again today. I'd like you to start by telling us a little bit about brain tumors and metastatic brain tumors. Tell us a little bit about this disease, what the general cause, what do we know about them now.

Dr Rajiv Magge: Thank you so much for having me. So when we think about brain tumors, I first just want to say outright to our audience that they're relatively uncommon. So even if you have a headache or a new neurologic issue, it's very unlikely still that you have a brain tumor.

When we think about brain tumors, we think about two big classifications. They could be either primary brain tumors, meaning they're coming from the brain itself, or a secondary brain tumor, also known as a brain metastasis. And that represents a tumor that came from a systemic cancer in the body and got in the blood and traveled up to the brain and colonized to create a mass in the brain. So, when we speak about primary brain tumors, typically, the main cause is a mutation in a cell. So normally, all the cells in our bodies, they have breaks on them. They have signals that tell them to stop growing and dividing when it gets crowded. Unfortunately, sometimes a light switch turns on in these cells, and that allows the cells to keep growing and dividing even when it's crowded. And if you have a growing population of cells that are essentially a clone of each other, then that's how you can develop a tumor.

So, I think, in terms of between primary brain tumors and secondary brain tumors, brain metastases or secondary brain tumors are much more common than primary brain tumors. And these are seen typically with cancers like lung cancer, breast cancer, and melanoma, a lot of potential causes. But typically, it's more that just as we get older, our cells are not as good at duplicating themselves and copying our DNA, and they're more likely to make mistakes when they're copying the DNA. And one mistake is a mutation that could allow these cells to grow uncontrollably.

Melanie Cole, MS: Well, I certainly appreciate doctor that you mentioned right at the offset that this is pretty rare, because we all get a headache and right away, that's what we think. So, speak to us about symptoms that would warrant a visit to a neurologist to begin with, because those symptoms, like you said, a headache and all of that, can be really scary when you're thinking along those lines.

Dr Rajiv Magge: Oh, of course, of course. I think any time any of us has a new symptom, we're like, "Oh my gosh," is this something you kind of go to the worst case scenario. And as you said, almost 50% of, people in the community have headaches and very few of them have a brain tumor. So first to start out, I think anything that you're concerned about, any new symptom, any new issue, I think that again will warrant evaluation. So if there's something you're worried about or you just want to have questions answered, I think that's a completely understandable reason to see a neurologist.

But I think for us, some of the most concerning symptoms that may make you at least go to the emergency room would be, in addition to a headache, having new trouble speaking, weakness on one side of the body or one side of the face, sensory trouble, new numbness, especially on one side of the body or the face, new trouble walking, vision changes. I think those would be the most concerning in terms of new neurologic symptoms, especially if they're relatively acute and hadn't occurred in the past. But in those circumstances, you probably want to go to the emergency room or make sure you're getting a pretty urgent evaluation.

Melanie Cole, MS: Well, because those also sound like stroke symptoms as well.

Dr Rajiv Magge: Exactly right. So, it's hard to distinguish based on symptoms alone what might be going on. As you said, some of the same symptoms that can occur with a stroke can also happen with a brain tumor. Typically, the difference is between the timelines. With a stroke, usually the symptoms are right away, kind of immediate, and they occur really hard and fast. With the brain tumor, as you can imagine, a tumor could potentially grow slowly. And if it grows slowly, you might have more slowly progressive deficits. So sometimes patients will say, "Oh, I've had symptoms developing over the past few months through the year." That's when we get more concerned about a tumor instead of a stroke.

Melanie Cole, MS: Thank you for clarifying that. Now, give us a little overview of some of the latest advancements in brain tumor treatments. What breakthroughs or innovations have emerged that really excite you in this field?

Dr Rajiv Magge: When we talk about brain tumors, this is a pretty large umbrella. So, there's a lot of different types of brain tumors. So, one thing I want to remind the audience is one person's brain tumor is very, very different than another person's. They could be completely different types, completely different molecular profiles and really completely different prognosis and outcomes and potential treatments.

From the outset, the most common primary brain tumors are gliomas, which are tumors of glial cells. And that includes the most aggressive type of glioma, glioblastoma, and also meningiomas. These are tumors that kind of, are coming from the sheath, the meninges that cover the brain.

I think the most exciting treatments in these venues are potentially more targeted therapies, meaning treatments that target the mutation, that light switch that's turned on in the first place. There's a ton of development in immunotherapies in the cancer space. And these are treatments that essentially take the brakes off of the own body's immune system to attack these tumors.

We also have much more sophisticated radiation therapy techniques, as well as really advanced and exciting surgical techniques, where, we are able to use potentially focused ultrasound or convection-enhanced delivery to better get drugs into the brain. This is also on the other side, when we look at metastatic tumors or there are secondary brain tumors that are coming from the body, there's really been a revolution in treatments for lung cancer, breast cancer, melanoma, and a lot of other systemic cancers that can go to the brain. And fortunately, a lot of these treatments are now getting into the central nervous system and penetrating past the blood brain barrier. And this just means that these treatments now are a potential option to treat brain mets either from an IV drug or through a pill.

Melanie Cole, MS: When you're working with patients, because this is one of the scarier cancers to hear about and someone getting this diagnosis, tell us a little bit about the multidisciplinary team and approach that you use, because I'm sure that there are so many specialists that it's important that they work with whether it's psychological help, family support, all of that works together.

Dr Rajiv Magge: Absolutely. I appreciate you bringing that up. When we think about brain tumors, it's really an interdisciplinary, big care team. You know, as neuro-oncologists, we work very closely with, of course, neurosurgeons, radiation-oncologists who have such expertise in delivering radiation to the brain; neuropathologists who kind of look at the pathology tissue under the microscope and do very sophisticated testing and molecular profiling of the tumor samples in addition to neuroradiologists who are really on the cutting edge of new imaging techniques to better assess brain tumors potentially help us diagnose before we go to surgery, and also even new treatment techniques that integrate radiologic advancements.

So, I think, yeah, as you said, we are working all as a group together in terms to create the best treatment plan for a patient. And especially for patients with gliomas, these can be very complex management regimens with an initial surgery, getting the pathology diagnosis and genetic testing on the tumor, not on the patient. It's very rare for these tumors to be inherited or passed on. But the neuropathologist does a lot of the sophisticated testing. Of course, we are working then with the radiation-oncologist, because many of these tumors can be very responsive to radiation therapy in tandem with potential chemotherapy drugs.

So, I think the key thing is to know that you have a big team behind you to really ask those questions that are important to you. Whenever we see a new patient, we really want to take into account everything about them, their families, what kind of care they have at home, what their functional status is in terms of doing their activities of daily living. Also knowing what their goals are, what are the important things that bring them joy. All of that is really taken into account when we come together with a tailored and customized treatment plan for every patient.

Melanie Cole, MS: So important. And I'd like you to speak, as we wrap up, what you would like patients to know about anything exciting in the field, things you're looking forward to, and what you want patients to know when they're going through that, or if their loved one is going through that, the support that is available as they go through it.

Dr Rajiv Magge: Yeah, absolutely. I think every day we are learning more about these tumors, and I think that's what's really exciting. the cancer space is moving at a very, very rapid clip, especially the past 5 to 10 years. And, in the past, for certain tumors like glioblastoma, there were pretty limited treatment options.

And I'm really hopeful that all of the new knowledge we have about the biology of these tumors and why they grow in the first place is going to translate soon to better treatments. I think some of the most exciting domains is within that immunotherapy I mentioned. Again, those treatments that essentially take the brakes off the own body's immune system to attack the tumor, there's a really revolutionary treatment called CAR T-cell therapy, and this is spelled out as chimeric antigen receptor T cells, and this is really revolutionized treatment of blood cancers such as lymphoma, leukemia and myeloma. And it's now potentially going to transform the treatment of other cancers as well.

Essentially in this treatment, we take your own body's T cells and then in the lab, they put receptors on those T cells so that when those are put back in your body, they go attack the tumor or cancer, wherever it is. And in the past, we didn't think this was going to be an option for brain tumors, but more recent studies have indicated that, there's potential success and efficacy for these tumors, albeit maybe temporarily. But if we see a potential response, the next goal is going to be extending that response. So, it makes me really hopeful that we're going to see a lot of progress in these immunotherapies, including CAR T-cells.

Melanie Cole, MS: Thank you so much, Dr. Magge, for joining us today. That was really an interesting and informative episode. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, Pandora, and Google Podcasts. For more health tips, go to wildcornell. org and search podcasts and parents. Don't forget to check out our kids healthcast.

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