Hattab – who also is the current chair of the – said personalized medicine holds the key to the tests that pathologists will be conducting this week and beyond. While glioblastoma tumors appear identical under the microscope, genetics determine a patient’s course of treatment. 

“Personalized medicine today allows for the classification of glioblastomas into two main categories based on their genetic makeup,” Hattab said. “About 90 percent of glioblastomas are ‘bad actors,’ usually with survival periods under one year, while the remainder of patients may live for about five years or longer.

Glioblastoma is a tumor that starts in the brain. It affects glial cells, which are glue-like cells that surround neurons. Glioblastoma tumors are especially hard to treat because they aren’t contained in a defined mass with clear borders. Instead, the tumor includes thread-like tendrils that extend into nearby areas of the brain, rendering the task of complete surgical resection virtually impossible. Chemo and radiation therapies present the patient with additional treatment options. 

That is why personalized medicine, with its emphasis on the patient’s tumor genetic makeup and practiced by a pathologist, is important in treating glioblastoma tumors, Hattab said.

“In addition to rendering the diagnosis of glioblastoma, the role of the pathologist is to determine to which genetic group a patient belongs,” he said. “While these tumors appear identical under the microscope, a tumor’s response to therapy and subsequently its clinical behavior differs from one patient to another depending on certain molecular characteristics.

“Through molecular testing, the laboratory is able to predict which tumors will respond better to certain chemotherapeutic and radiation therapies.”

Aldape was part of an international team of medical researchers contributing to the 2016 World Health Organization Classification of Tumors of the Central Nervous System (2016 WHO CNS), which sets the international standard for describing and classifying tumors of the central nervous system. The 2016 edition provides universal terminology allowing physicians and researchers to define tumors based not only on their morphology (the form and structure of the tumors), but also on their molecular characteristics (genetic mutations or structural variants). These standards ultimately will facilitate more precise and effective treatments for patients.

“These new classifications position us on the path of delivering precision medicine,” said Eyas Hattab, MD, MBA, chair of the UofL Department of Pathology and Laboratory Medicine. “This will allow physicians to tailor treatments more specifically to the individual patient’s tumor.”

For example, prior to the 2016 CNS WHO, a tumor may have been identified as glioblastoma based on its location and cell structure. The revised classification now provides universal terminology to identify the tumor as either IDH-mutant or IDH-wildtype, based on molecular characteristics. This refinement will allow for more accurate prognosis for patients and the potential development of specific treatments for different tumors.

“If we know these are molecularly distinct entities, it gives us the opportunity to study their behaviors. We can come back in a few years and say that based on our studies, these behave better or worse or they can benefit from the following treatments,” Hattab said.

Also at the July 8 UofL symposium, Michael Prados, MD, co-project leader of the Pacific Pediatric Neuro-Oncology Consortium, will discuss current research in the area of precision-based therapies for patients with recurrent glioblastomas.

The agenda for the JGBCC Neuro-oncology Symposium on July 8 is as follows: 

Introduction and overview of primary glioma – assistant professor in the UofL Department of Neurology and director of neuro-oncology at JGBCC.

Surgical intervention for primary glioma – chair and professor of the Department of Neurosurgery at the University of Texas MD Anderson Cancer Center in Houston. Sawaya’s presentation will cover the advantages of radical surgery for primary brain tumors and the technological advances that have allowed such surgeries with reduced morbidity.

Radiation oncology for primary glioma – chair and professor in the UofL Department of Radiation Oncology, professor in the UofL Department of Pediatrics and the Kosair Children’s Hospital/Norton Healthcare Chair in Pediatric Oncology.

Chemotherapy and clinical trials for adult glioma – Charles B Wilson Chair in Neurosurgery and professor emeritus at the University of California San Francisco. Prados will discuss research in the area of precision-based therapies for patients with recurrent glioblastomas.

Molecular markers for adult glioma – senior scientist and director of MacFeeters-Hamilton Brain Tumor Centre at Toronto General Hospital and professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto.

The symposium is co-hosted by the UofL Department of Neurology and the James Graham Brown Cancer Center, a part of KentuckyOne Health. Registration begins at 7:15 a.m. on Friday, July 8, at the Kosair Charities Clinical and Translational Research Building, 505 South Hancock Street on the University of Louisville Health Sciences Campus.

Continuing education credit is available for health care providers. The event is free for UofL-affiliated providers, $15 for nurses and $20 for all others. For additional information, visit the or email Emily Rollins.

“Management of Primary Glioma in Adults,” co-hosted by the UofL Department of Neurology and the James Graham Brown Cancer Center, a part of KentuckyOne Health, will be Friday, July 8 from 7:15 a.m. to 1 p.m. at the Kosair Charities Clinical and Translational Research Building, 505 S. Hancock St. on the University of Louisville Health Sciences Campus. The event is open to patients and their families, as well as physicians and health care professionals.

Conference director Eric Burton, MD, assistant professor in the UofL Department of Neurology and director of neuro-oncology at JGBCC, will provide an overview of adult glioma, a tumor that develops in the supportive tissue of the brain. Presenters from MD Anderson Cancer Center, University of California, San Francisco, Toronto General Hospital and the University of Louisville will then address best current practices and future treatment directions for patients with primary gliomas using surgery, radiation and chemotherapy, as well as a discussion of molecular markers in adult glioma.

“These are some of the most influential and highly respected physician researchers in neuro-oncology and neuropathology,” Burton said. “This is an excellent opportunity for physicians across the region, as well as patients and their families, to learn about the latest developments in the pathology and treatment of brain tumors.”

In addition to Burton, presenters include:

senior scientist and director of MacFeeters-Hamilton Brain Tumor Centre at Toronto General Hospital and professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. Aldape is a neuropathologist with a research interest in primary brain tumors. His work includes the identification of biomarkers in gliomas, characterizing glioma subtypes and identifying clinically relevant molecular alterations in these tumors. In 2014, Aldape received the Guha Award for Excellence in Neuro-Oncology Research from the Society for Neuro-Oncology.

Charles B Wilson Chair in Neurosurgery and professor emeritus at the University of California San Francisco. Prados led the North America Brain Tumor Consortium for 15 years and was co-project leader of the Adult Brain Tumor Consortium until 2014. He formed and is co-project leader of the Pacific Pediatric Neuro-Oncology Consortium, a consortium of 15 major academic centers across the U.S., and is co-project leader of a pediatric brain tumor SPORE project at UCSF. Prados has been NIH/NCI funded continuously since 1994 and is a member of the NCI/CTEP Brain Malignancies Steering Committee. In 2014, he was awarded the Victor Levin Award for lifetime clinical research excellence from the Society of Neuro-Oncology.

chair and professor of the Department of Neurosurgery at the University of Texas MD Anderson Cancer Center in Houston. He is director of the Brain Tumor Center at MD Anderson and served as professor and chair of the Department of Neurosurgery at Baylor College of Medicine from 2005-2014. His awards include the Joseph P. Evans Award in Neurosurgery at the University of Cincinnati and the Charles Wilson Award from the National Brain Tumor Society. He is past chairman of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Tumors. Sawaya has particular expertise in primary and metastatic brain tumors and is renowned for his strides in enhancing the accessibility and safety of brain tumor surgery.

chair and professor in the UofL Department of Radiation Oncology, professor in the UofL Department of Pediatrics and the Kosair Children’s Hospital/Norton Healthcare Chair in Pediatric Oncology. His clinical focus and research is on brain and spine tumors, pediatric cancer and lung cancer. Woo has received Clinical Fellowship Awards from the American Cancer Society, Teacher of the Year Award from the Association of Residents in Radiation Oncology and the Patient Golden Apple Award from the MD Anderson Cancer Center. He also served as president of the MD Anderson Radiation Oncology Gilbert H. Fletcher Society.

Continuing education credit is available for health care providers. The event is free for UofL-affiliated providers, $15 for nurses and $20 for all others. For additional information, visit the or contact Emily Rollins at emily.rollins@louisvilleneuroscience.com.

Burton, assistant professor in UofL’s Department of Neurology, director of neuro-oncology at JGBCC, and neuro-oncologist with UofL Physicians, is seeking participants for a clinical trial at the James Graham Brown Cancer Center, a part of KentuckyOne Health, to test a new treatment for recurrent GBM that attempts to halt tumor growth by reducing the blood supply to the tumor. Participants will be accepted for the trial over the next year.

The therapy to be tested aims to halt tumor growth by limiting the tumor’s blood supply, a process called angiogenesis inhibition, which is a well-established tumor treatment method. It uses VB-111, a modified version of a common virus, that delivers a gene specifically to the endothelial cells that spawn blood vessels for the tumor. The expression of this gene in the blood vessel cell causes cell death, resulting in decreased blood flow to the tumor. The VB-111 virus can be given to patients systemically with tolerable side effects and, based on early trial studies, it may improve survival in patients with recurrent GBM.

Avastin is an FDA approved drug for the treatment of recurrent GBM. In this trial, participants who experience either a first or a second recurrence of GBM will be randomized to be treated with either Avastin alone or Avastin with VB-111. The goal of the study is to determine if the addition of VB-111 to Avastin improves survival over treatment with Avastin alone.

The trial is open to adults over 18 years of age initially diagnosed with GBM who have already received upfront standard treatment with radiation and Temodar at initial diagnosis. Patients can only be in their first or second recurrence and may not have received previous therapy with Avastin or any other angiogenesis inhibitor.

The Brown Cancer Center currently is the only site in this region participating in the international clinical trial. To learn more about the trial, patients may contact the Brown Cancer Center at 502-562-3429 or email ctoinfo@louisville.edu.