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.Ěý

“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.Ěý

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.”

Neuro-oncology experts from across North America provided an audience the latest developments on the best current practices and future treatment directions for patients with primary gliomas using surgery, radiation and chemotherapy at the second annual James Graham Brown Cancer Center Neuro-oncology Symposium at UofL earlier this month.

Eric Burton, MD, assistant professor in the UofL Department of Neurology and director of neuro-oncology at the James Graham Brown Cancer Center, organized the symposium, sponsored by UofL Department of Neurology and JGBCC, a part of KentuckyOne Health. Burton talked with Mark Hebert for about brain tumors prior to the event.

Among the speakers was Raymond Sawaya, MD, chair and professor of the Department of Neurosurgery at the University of Texas MD Anderson Cancer Center, who explained that radical surgical procedures to remove as much of a glioblastoma as possible most often results in improved overall survival for the patient. He described how cortical mapping and advanced imaging can allow surgeons to remove more of the tumor while preserving functionality and reducing potential deficits in the patient.

Shiao Woo, MD, chair and professor in the UofL Department of Radiation Oncology, outlined the latest developments in radiation treatment for gliomas, including the use of molecular characteristics in guiding treatment choices.

Michael Prados, MD, the Charles B Wilson Chair in Neurosurgery and professor emeritus at the University of California San Francisco, shared his most recent research to establish protocols for treatment plans using precision medicine.

Kenneth Aldape, MD, senior scientist and director of MacFeeters-Hamilton Brain Tumor Centre at Toronto General Hospital, concluded the program with a discussion of the need to identify tumors as precisely as possible to achieve better outcomes for patients experiencing glioma. Aldape participated in the development of new tumor classifications by the World Health Organization released earlier this year. The classifications allow researchers to identify the tumors by not only histological, but also molecular composition, which will allow researchers to develop more precise therapies for treating specific tumors.

Photos from the symposium are .Ěý

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.ĚýThe 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.