A neuro-oncologist explains common brain tumors and new approaches to treatment.

Story by: Rebecca Hall on February 27, 2019

Common brain tumor types, such as astrocytoma and glioblastoma, can be hard to pronounce and difficult to understand.

“Generally, it’s critically important to understand whether a brain tumor is primary or metastatic,” said Renato V. LaRocca, M.D., a neuro-oncologist and cancer medicine specialist with Norton Cancer Institute. “Primary means the tumor originated in the brain. Secondary or metastatic means it spread from another part of the body.”

Astrocytoma

One of the more common kinds of primary brain tumor is called an astrocytoma. When this type of tumor is malignant, or cancerous, it has a high tendency to recur after initial removal.

Glioblastomas

Glioblastomas are highly malignant and the most aggressive type of astrocytoma (grade 4).  They account for about 15 percent of all brain tumors, and primarily occur in adults between ages 45 and 70. As this type of brain tumor grows, it leads to pressure on the brain, which can cause symptoms such as headaches, nausea, vomiting, drowsiness and sudden seizures. It used to be a devastating illness with few people surviving beyond a few months.

“Today, with innovative multimodality treatments, or treatments that combine more than one method, patients can survive on average between one to two years,” said Dr. LaRocca.  “Every once in a while, something wonderful happens and they can survive well beyond three to five years.”

More treatment options for brain cancer provide better results

“Over the past ten years we’ve seen tremendous gains in our biological understanding of glioblastomas and significant advances in our treatment approaches and options,” Dr. LaRocca said.

Treatment options for brain cancer include surgery, radiation, and chemotherapy, as well as newer approaches and clinical trials, including:

• Avastin, an intravenous drug that works by cutting off a tumor’s blood supply.
• Optune, a unique noninvasive portable treatment device. Patients wear a skullcap with electrodes that connect to an electrical field generator that can be carried in a backpack. The generator produces low-dose, alternating electrical “tumor targeting fields” (TTFs) that disrupt cancer cells’ ability to reproduce quickly.
• Immunotherapy, which uses the brain’s own natural immune system to fight the tumor cells. The effort focuses on checkpoints — molecules that suppress the body’s immune response. Cancer cells sometimes use these and related molecules as a way to slip through the immune system unharmed and unseen. Immunotherapy drugs often will seek to unblock the checkpoint, unmasking the cancer cell as a target for the immune system.

Norton Cancer Institute has ongoing clinical trials to investigate new treatment options for primary brain tumors including grade 3 astrocytomas and glioblastomas.  These range from vaccines, to checkpoint inhibitors and novel targeted agents.