8 brain tumor treatment questions, answered

A brain tumor diagnosis and treatment can bring many questions. That’s why John de Groot, M.D., co-leader of our Glioblastoma Moon Shot™, and Jeffrey Weinberg, M.D., recently took time to answer questions submitted online by brain tumor patients and caregivers.

Here are their responses to eight of the top questions we received about brain tumor treatment.

What treatment options are available for patients facing a brain tumor recurrence?

Weinberg: If there’s a mass that can be safely removed, we remove it. This may alleviate symptoms and allows us to verify whether it’s truly a recurrence, or something else (like dead tissue) that just looks like a tumor on the MRI. Removing the tumor tissue also allows us to perform molecular analysis to see if the patient is eligible for a clinical trial.

What if my brain tumor is inoperable?

Weinberg: Whether a brain tumor is operable depends on its size, location, the symptoms it’s causing and the experience of the operating team. We perform many second opinions for patients with “inoperable” tumors. Because of the experience of our neurosurgeons and the technology available at MD Anderson, we’re able to safely operate on many tumors that would be considered inoperable somewhere else.

We also have options to treat inoperable tumors without physically removing them, including laser interstitial thermal therapy (LITT). 

How and why are low-grade gliomas treated differently than more aggressive brain tumors like glioblastoma?

de Groot: “Low-grade glioma” typically refers to a grade II astocytoma or oligodendroglioma. Several recent Phase III clinical trials have shown that oligodendroglioma is very treatable and that patients with this disease can live for many years after treatment. With good survivorship for low-grade gliomas, we want to minimize the potential impact of aggressive therapy to the brain, which can affect quality of life.  

How do you treat cancer that spreads to the brain from elsewhere in the body?

de Groot: Solid tumor cancers such as lung cancer, breast cancer and melanoma can spread to the brain. These tumors are called brain metastases. For a single tumor, we may consider surgery. If there are multiple tumors, radiation or radiosurgery is typically used. Now, targeted therapy and immunotherapy are also options for some patients.

Weinberg: We recently started a tumor board for patients with metastatic disease. This allows MD Anderson oncologists to meet with our neuro-oncology, neurosurgery and central nervous system radiation oncology teams to create a tailored treatment plan for each patient with brain metastases.

What are the most promising developments in brain tumor treatment?

Weinberg: We’re discovering and treating metastatic brain tumors when they’re smaller, thanks to earlier MRIs. For primary brain tumors, we’re now imaging functional brain nerves (which control movement, speech and other important functions) with greater accuracy and using that information in our surgical plan. That makes surgery safer.

Metabolic imaging is a new technique that helps us interpret changes in the tumor that develop over time. It’s also helping us differentiate between tumor regrowth and lesions caused by brain tumor treatment.  

Laser interstitial thermal therapy is another promising development that appears to be very effective in treating certain tumors. Laser interstitial thermal therapy works by inserting a probe directly into the tumor and heating it enough to destroy the tumor from the inside. Real-time MRI temperature monitoring makes it possible to do this safely. 

What’s the status of developing immunotherapy for glioblastoma?

de Groot: We’re currently introducing immunotherapy treatments to glioblastoma patients through clinical trials. From what we’re seeing, the checkpoint inhibitors that have worked in melanoma and lung cancer are probably not a home run for glioblastoma. We’re now testing combination therapies that combine a checkpoint inhibitor with another therapy in clinical trials.

Other immunotherapy trials use a patient’s own cells, like T cells or natural killer cells, and reprogram them to attack the brain tumor. We’re hopeful that immunotherapy will make a big difference for glioblastoma. 

What other types of clinical trials are available for brain cancer?

de Groot: Besides immunotherapy, we have two other types of clinical trials:

• Targeted therapy for tumors that have specific molecular markers
• Biologic therapies using Delta-24, a cancer-killing virus developed at MD Anderson

We also have trials for meningioma, leptomeningeal disease and other brain tumors. See our brain tumor clinical trials here.

What’s your advice for brain tumor patients and caregivers?

de Groot: You’re an individual, not a statistic. You’re not going to have the same experience as other brain tumor patients. Live every day to its fullest and stay optimistic, with the expectation that none of us can predict exactly what’s going to happen.

Weinberg: Remember, it might be your first time going through brain tumor treatment, but it’s not ours.

Watch answers to more brain tumor questions in this Facebook video Q&A.

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