Glioblastoma (GBM) Awareness Day – A Difficult Brain Tumor

July 22, 2020 is Glioblastoma Awareness Day.

Glioblastoma (GBM) is one of the most notorious forms of brain cancer and one of the most challenging malignancies to treat in all of oncology.

It has made headlines in recent years with high-profile political figures such as Beau Biden, Ted Kennedy and John McCain, all of whom died within a short time of diagnosis

What is glioblastoma?

We asked Santosh Kesari, MD, PhD, a world-renowned neuro-oncologist and one of the founders of Pacific Neuroscience Institute, to walk us through what is glioblastoma and why treatment for this disease has been challenging.

Types of GBM

“There are two types of glioblastomas: primary, originating de novo, and secondary, evolving from lower-grade gliomas,” said Dr. Kesari, who also serves as director of neuro-oncology at Providence Saint John’s Health Center and chair of the Department of Translational Neurosciences and Neurotherapeutics at Saint John’s Cancer Institute. 

Patients diagnosed with these tumors generally have a dismal prognosis and poor quality of life as the disease progresses. On average in the United States, an estimated 13,000 patients are diagnosed with GBM annually, with a life expectancy of about 14 months, and a 5-year survival rate of 5%. The incidence increases dramatically after the age of 54 years and reaches a peak incidence at age 75-84 years.

Symptoms of GBM

“One of the most common symptoms is a headache, which differs from a typical tension or migraine headache. Other symptoms which may occur alone or in combination include persistent weakness, numbness, blurred vision, balance issues, seizure, changes in memory, or alteration of language,” said Dr. Kesari. “In a vast majority of patients, there is no cause of the disease, but we presume there is an initial molecular event in a cell that starts to become cancerous.” The only well-established causative factor for GBM is exposure to ionizing radiation, but this accounts for only a small minority of cranial tumors. Currently, MRI imaging provides the most sensitive tool for the initial detection of GBM, however once a GBM is identified, the tumor is already at an advanced state.

The standard of care therapy consists of debulking surgery, followed by radiation and temozolomide chemotherapy. The radiation and chemotherapy agent damages the DNA in tumor cells that are actively dividing. “This is a good thing because we want to shrink the tumor,” Dr. Kesari explained.

Why is glioblastoma difficult to treat?

• Heterogeneity – there is a high degree of variation (heterogeneity) within the same tumor cells that makes each individual glioblastoma molecularly distinct. This can be challenging when predicting prognosis and treatment
• Location of tumor – if it is in an area which is difficult access, or too close to major blood vessels or other important centers of the brain, it can make surgery tough
• Recurrence – tendency of the tumor to come back aggressively

When treating brain tumors Dr. Kesari commented, “What makes treatment challenging is that you have tumor cells that are not active, meaning they are dormant.” These cells are known as cancer stem cells and since they are not active they do not die by radiation and chemotherapy. 

Clinical Trials and Research for Glioblastoma

Dr. Kesari has been making headway in the fight against glioblastoma by developing treatment methods that target and destroy cancer stem cells. One current study, Neurological Outcomes aims to identify the difference between those patients who do well and those whose tumors return quickly.

“There is a need for better therapies in brain cancer patients, and by studying the molecular genetic of patients, I believe we are on the verge of getting there,” he said. “Many of these challenges are currently being studied in clinical trials and by having an understanding of glioblastoma we hope to soon have a cure.”

Dr. Kesari, Director, Neuro-oncology; Chair and Professor, Department of Translational Neurosciences and Neurotherapeutics

Currently, there are several active clinical trials being conducted at Saint John’s Cancer Institute and Pacific Neuroscience Institute. These are new treatment approaches for those who are newly diagnosed with glioblastoma, and those who have recurrent disease.

One of Dr. Kesari’s main objectives is to help cancer patients gain access to promising clinical trials based on thorough research and evaluation of published data. With his own experience in therapies like immunotherapy, which reprograms the immune system to identify and attack cancer cells, to precision therapeutic strategies that target brain tumors at the molecular level to eliminate the disease, he believes there is hope in the fight against GBM.

GBM Awareness Day 2020

July 22 marks Glioblastoma Awareness Day in the United States. Dr. Kesari encourages everyone to make an impact by using the official hashtag #GBMDay for Glioblastoma Awareness Day.

This is a day to honor those who have faced glioblastoma as well as to highlight how strong and resilient glioblastoma patients and their caregivers are because of their journey, and to recognize the tireless work of medical providers and researchers to find a cure.

About Dr. Santosh Kesari

Dr. Kesari is a world-renowned neuro-oncologist with extensive experience treating all types of malignant brain tumors with particular emphasis on gliobastomas. A physician-scientist and recipient of Castle Connolly’s TopDoctor Award, he and his team conduct leading-edge research and clinical trials in immunotherapy and biomarker-based therapies.