As we hear more about people passing away from Glioblastoma, you might have questions about this form of brain cancer.
Shinoj Pattali, MD, explains Glioblastoma, what treatment options are available and some of the promising new therapies for this type of cancer.
What is Glioblastoma?
From the Show: Memorial Ohio - Memorial Health Radio
Summary:
Air Date: 9/6/18
Duration: 10 Minutes
Transcription:
Melanie Cole, MS: In the wake of political figures passing away from glioblastoma, you might have questions about this form of brain cancer. My guest today is Dr. Shinoj Pattali. He’s a hematologist oncologist at Memorial Health System. Dr. Pattali, what is glioblastoma that we’ve been hearing so much in the media about lately.
Shinoj Pattali, MD: It is one of very aggressive brain tumor where the cancer cells very aggressively multiple. They're graded into different grades, I think, from grade one being less aggressive and grade two and three more aggressive. The most aggressive one would be grade four, and that is the glioblastoma of the brain.
Melanie: Who is at risk? Is there a genetic component to this? Is it random? And also, is it considered a primary cancer or a metastases from something else?
Dr. Pattali: For the most part, this is considered as a primary cancer of the brain. Usually it does not metastasize anywhere else. It’s a primary brain cancer. It’s very aggressive. There have been some genetics influences, very variably, that has been associated with the brain tumors. For most people, this happens in the late 60s and 70s and most of the time they’re random when we revelate for some of the symptoms.
Melanie: So, let’s talk about the symptoms them. People get a headache Dr. Pattali, and they right away think the worst—brain tumor, something. What are some specific symptoms and diagnostic criteria that would send somebody to see—whether it was a neurologist or their primary care provider—what would a person notice that would send up some red flags?
Dr. Pattali: So, and like I said these are rare brain tumors. Only less than 1 to 2% of cancers. Very rare. So, there are no specific symptoms, but symptoms that would sometimes be associated is persistent headaches, nausea, vomiting. Those are generally associated with any headache or migraine headaches, but if they are persistent that needs to elevate it. The age group that this is seen more commonly is the late 60s and 70s. But, since this being a rare tumor, there’s no screening tests or specific testing available. Symptom wise, this is usually common symptoms are mostly headaches or nausea and vomiting.
Melanie: You mentioned staging. So, as you diagnose this type of brain tumor, tell us a little bit about the staging. Then what are the standard courses of treatment for this right now?
Dr. Pattali: So, in brain tumors, we don’t generally call it staging as we apply this to a lung cancer or breast cancer because generally these type of tumors stay in the brain and they rarely metastasize. They are very aggressive cancers. They grow in any area of the brain. They have these tentacles that infiltrate to the rest of the brain tissue outward. They tend not to go outside of the brain to any other parts of the body. So pretty much anybody who is diagnosed is infinite at one stage.
Melanie: What are you doing if somebody is diagnosed with glioblastoma? What’s the standard course of treatment?
Dr. Pattali: If they're diagnosed with it based on an MRI scan of their brain, neurosurgeons do a surgery of the brain initially to biopsy it to confirm if it’s a glioblastoma or not. Then they try to remove it to the fullest extent possible or resect it out. Unfortunately, due to the way that the tumor spreads, through these tentacles infiltrate to the rest of the brain, it’s never completely removed surgically. They can try to remove it to the fullest extent possible, but following that surgically, the patient undergoes chemotherapy and radiation to control the rest of the disease outside of the main tumor site. That would be the more definitive treatment which involves chemotherapy pills and radiation after the complete resection.
Melanie: Dr. Pattali tell us about some promising new therapies as immunotherapy or CAR T cells. Are there anything new on the horizon that you see coming down the pike for glioblastoma?
Dr. Pattali: Yes. So, as we know, there are new treatments coming out every year. For the last couple of years, the newer things beyond chemotherapy or radiation or surgery was the advent of this tumor treating field of Optune. Optune is a company that makes this tumor treating field, which is a device people wear in their head. That produces this treatment field that also shrinks and controls cancer. This has been approved in combination with the chemotherapy and radiation upfront. Patient continues to wear that throughout the course of their disease. It has shown to help overall survival benefit in the treatment course.
CAR T cells has shown some promise. There has been research done on genetically engineered T cells where we make the immune system fight this cancer. There have been ongoing trials that are interesting. Trials are not mature yet to be used for everybody, but that is in the horizon. Immunotherapy as well. They’re not approved yet, but there are some trials ongoing considering immunotherapy as well. CAR T seems more promising.
Melanie: Dr. Pattali, you’ve mentioned that this is a very aggressive form of brain cancer. When do you discuss with a patient about stopping treatment and starting to plan for end of life care? What does that discussion look like with the patient and their family?
Dr. Pattali: So, if you look at the natural history of this cancer, there are certain mutations that we check for called MGMT methylation, which tells you whether the chemotherapy works better for this person or not. There are some mutations called IDH 1 and 2 mutations, which sometimes predicts mutation. If it’s a mutant variety, they have a better prognosis than having a Y type IDH. If you look at the average lifespan once you’re diagnosed with this, it’s 11 to 15 months is the range of that. If you have a mutation, it could be longer— 24 to 30 months. So, depending on that, the prognosis can be different. Overall, for the most part, the maximum surgery followed by chemotherapy and radiation and tumor treating fields is the upfront approach and most people benefit from that. Once it recurs after a year or so, the treatments are… There are second line and third line treatment options, but it gets progressively less beneficial at that point in time. We start involving palliative care and discuss with the family about transitioning to hospice care or end of life care at that point in time.
Melanie: What does that look like Dr. Pattali? What are the goals of hospice care for somebody that is suffering from glioblastoma?
Dr. Pattali: So, depending on the location of the tumor, sometimes there can be personality changes if they are located in the center of the brain. Sometimes it can affect the ability to make decisions. With the radiation, patients can have memory loss. They may not be able to handle their situations in a daily life very well. So, a lot of times, these patients need a lot of support from the family and the caregiver in terms of making decisions. We try to involve palliative care or hospice upfront because it involves personality, it involves function and memory and intelligence and all that. So, a lot of times we try to involve palliative care to make decisions on appointing power of attorney and whether we need to facilitate or not. A lot of times, it’s better to have these discussions earlier when they're able to make these decisions themselves and talk to next of kin or family member to help us make the decisions, to plan for future care. A lot of times, depending on the needs, it may involve hospice or sometimes family members can take care of it until the end of life.
Melanie: So, wrap it up. As people have been hearing so much more about this rare type of tumor in the media, Dr. Pattali, just wrap it up. What you want the take-home message to be about this and what you would like people to know.
Dr. Pattali: I would say this is a very aggressive type of brain tumor. Fortunately, it’s not very common in local indents, and there are treatment options for this and there are more promising treatments on the horizon. So most of the treatment, if you're in 60s or 70s age group and you have this persistent headache or nausea or vomiting, it’s better to check it out. If you find a tumor, biopsy, do the full resection surgery upfront and do chemotherapy radiation and do the appropriate treatment, the survivability is up to a year and a half to two overall. Some people can battle that outcome and there are more treatments coming up. I think patients should be hopeful because of the newer treatments and the current treatments that can extend life and preserve their quality of life. Being this is an aggressive tumor; the outcome is not as great as we want it to be. There’s still reason to hope for good treatments and good quality of life.
Melanie: Thank you so much doctor for joining us today and sharing your expertise and clearing up some of the confusion that people have been hearing about this. Thank you so much. You're listening to Memorial Health Radio with Memorial Health System. For more information, please visit mhsystem.org. That’s mgsystem.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole, MS: In the wake of political figures passing away from glioblastoma, you might have questions about this form of brain cancer. My guest today is Dr. Shinoj Pattali. He’s a hematologist oncologist at Memorial Health System. Dr. Pattali, what is glioblastoma that we’ve been hearing so much in the media about lately.
Shinoj Pattali, MD: It is one of very aggressive brain tumor where the cancer cells very aggressively multiple. They're graded into different grades, I think, from grade one being less aggressive and grade two and three more aggressive. The most aggressive one would be grade four, and that is the glioblastoma of the brain.
Melanie: Who is at risk? Is there a genetic component to this? Is it random? And also, is it considered a primary cancer or a metastases from something else?
Dr. Pattali: For the most part, this is considered as a primary cancer of the brain. Usually it does not metastasize anywhere else. It’s a primary brain cancer. It’s very aggressive. There have been some genetics influences, very variably, that has been associated with the brain tumors. For most people, this happens in the late 60s and 70s and most of the time they’re random when we revelate for some of the symptoms.
Melanie: So, let’s talk about the symptoms them. People get a headache Dr. Pattali, and they right away think the worst—brain tumor, something. What are some specific symptoms and diagnostic criteria that would send somebody to see—whether it was a neurologist or their primary care provider—what would a person notice that would send up some red flags?
Dr. Pattali: So, and like I said these are rare brain tumors. Only less than 1 to 2% of cancers. Very rare. So, there are no specific symptoms, but symptoms that would sometimes be associated is persistent headaches, nausea, vomiting. Those are generally associated with any headache or migraine headaches, but if they are persistent that needs to elevate it. The age group that this is seen more commonly is the late 60s and 70s. But, since this being a rare tumor, there’s no screening tests or specific testing available. Symptom wise, this is usually common symptoms are mostly headaches or nausea and vomiting.
Melanie: You mentioned staging. So, as you diagnose this type of brain tumor, tell us a little bit about the staging. Then what are the standard courses of treatment for this right now?
Dr. Pattali: So, in brain tumors, we don’t generally call it staging as we apply this to a lung cancer or breast cancer because generally these type of tumors stay in the brain and they rarely metastasize. They are very aggressive cancers. They grow in any area of the brain. They have these tentacles that infiltrate to the rest of the brain tissue outward. They tend not to go outside of the brain to any other parts of the body. So pretty much anybody who is diagnosed is infinite at one stage.
Melanie: What are you doing if somebody is diagnosed with glioblastoma? What’s the standard course of treatment?
Dr. Pattali: If they're diagnosed with it based on an MRI scan of their brain, neurosurgeons do a surgery of the brain initially to biopsy it to confirm if it’s a glioblastoma or not. Then they try to remove it to the fullest extent possible or resect it out. Unfortunately, due to the way that the tumor spreads, through these tentacles infiltrate to the rest of the brain, it’s never completely removed surgically. They can try to remove it to the fullest extent possible, but following that surgically, the patient undergoes chemotherapy and radiation to control the rest of the disease outside of the main tumor site. That would be the more definitive treatment which involves chemotherapy pills and radiation after the complete resection.
Melanie: Dr. Pattali tell us about some promising new therapies as immunotherapy or CAR T cells. Are there anything new on the horizon that you see coming down the pike for glioblastoma?
Dr. Pattali: Yes. So, as we know, there are new treatments coming out every year. For the last couple of years, the newer things beyond chemotherapy or radiation or surgery was the advent of this tumor treating field of Optune. Optune is a company that makes this tumor treating field, which is a device people wear in their head. That produces this treatment field that also shrinks and controls cancer. This has been approved in combination with the chemotherapy and radiation upfront. Patient continues to wear that throughout the course of their disease. It has shown to help overall survival benefit in the treatment course.
CAR T cells has shown some promise. There has been research done on genetically engineered T cells where we make the immune system fight this cancer. There have been ongoing trials that are interesting. Trials are not mature yet to be used for everybody, but that is in the horizon. Immunotherapy as well. They’re not approved yet, but there are some trials ongoing considering immunotherapy as well. CAR T seems more promising.
Melanie: Dr. Pattali, you’ve mentioned that this is a very aggressive form of brain cancer. When do you discuss with a patient about stopping treatment and starting to plan for end of life care? What does that discussion look like with the patient and their family?
Dr. Pattali: So, if you look at the natural history of this cancer, there are certain mutations that we check for called MGMT methylation, which tells you whether the chemotherapy works better for this person or not. There are some mutations called IDH 1 and 2 mutations, which sometimes predicts mutation. If it’s a mutant variety, they have a better prognosis than having a Y type IDH. If you look at the average lifespan once you’re diagnosed with this, it’s 11 to 15 months is the range of that. If you have a mutation, it could be longer— 24 to 30 months. So, depending on that, the prognosis can be different. Overall, for the most part, the maximum surgery followed by chemotherapy and radiation and tumor treating fields is the upfront approach and most people benefit from that. Once it recurs after a year or so, the treatments are… There are second line and third line treatment options, but it gets progressively less beneficial at that point in time. We start involving palliative care and discuss with the family about transitioning to hospice care or end of life care at that point in time.
Melanie: What does that look like Dr. Pattali? What are the goals of hospice care for somebody that is suffering from glioblastoma?
Dr. Pattali: So, depending on the location of the tumor, sometimes there can be personality changes if they are located in the center of the brain. Sometimes it can affect the ability to make decisions. With the radiation, patients can have memory loss. They may not be able to handle their situations in a daily life very well. So, a lot of times, these patients need a lot of support from the family and the caregiver in terms of making decisions. We try to involve palliative care or hospice upfront because it involves personality, it involves function and memory and intelligence and all that. So, a lot of times we try to involve palliative care to make decisions on appointing power of attorney and whether we need to facilitate or not. A lot of times, it’s better to have these discussions earlier when they're able to make these decisions themselves and talk to next of kin or family member to help us make the decisions, to plan for future care. A lot of times, depending on the needs, it may involve hospice or sometimes family members can take care of it until the end of life.
Melanie: So, wrap it up. As people have been hearing so much more about this rare type of tumor in the media, Dr. Pattali, just wrap it up. What you want the take-home message to be about this and what you would like people to know.
Dr. Pattali: I would say this is a very aggressive type of brain tumor. Fortunately, it’s not very common in local indents, and there are treatment options for this and there are more promising treatments on the horizon. So most of the treatment, if you're in 60s or 70s age group and you have this persistent headache or nausea or vomiting, it’s better to check it out. If you find a tumor, biopsy, do the full resection surgery upfront and do chemotherapy radiation and do the appropriate treatment, the survivability is up to a year and a half to two overall. Some people can battle that outcome and there are more treatments coming up. I think patients should be hopeful because of the newer treatments and the current treatments that can extend life and preserve their quality of life. Being this is an aggressive tumor; the outcome is not as great as we want it to be. There’s still reason to hope for good treatments and good quality of life.
Melanie: Thank you so much doctor for joining us today and sharing your expertise and clearing up some of the confusion that people have been hearing about this. Thank you so much. You're listening to Memorial Health Radio with Memorial Health System. For more information, please visit mhsystem.org. That’s mgsystem.org. This is Melanie Cole. Thanks so much for listening.
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