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About glioblastoma

Glioblastoma (GBM) is the most common and most aggressive form of adult primary brain cancer. Annually 250,000 - 300,000 patients globally are diagnosed with brain and nervous system tumours, of which GBM is the most common and despite advances in care, there is no definitive cure currently available. Therefore, it is vital that new treatments for GBM tumours be developed in order to address the poor outcome for GBM patients.

Two of the main causes of treatment failure are the invasion of tumour cells into the surrounding brain tissue, and the extreme resistance of tumour cells to radiation and chemotherapy. The invasive nature of this type of tumour makes complete surgical removal impossible, leading to recurrence of tumour growth. Thus, it is imperative that any new treatment strategy addresses the invasive nature of the tumour. However, at present there are no anti-invasion therapies available for use in the clinic for GBM patients.

 

Key facts

  • Occurs more commonly in men.

  • Occurs more commonly in those over 50 years of age.

  • GBM is more common in Caucasian, Hispanic and Asian populations.

  • Diagnosis is made through MRI, CT and tumour pathological examination.

  • Classified as a Grade IV diffuse glioma.

  • Typical symptoms include: Nausea, vomiting, seizures, cognitive disturbances, focal neurological deficit.

  • Cells can migrate far from the tumour bulk and rapidly divide.

  • The "blood-brain-barrier", which usually protects the brain from chemicals, creates a barrier to normal treatment options.

  • The genetic heterogeneity makes these tumours extremely difficult to treat.

  • There are 3 "subtypes" based on the genetics of GBM cells which are Classical, Proneural and Mesenchymal. These subtypes can coexist within the same tumour and tumours are also able to switch from one subtype to another. The subtype of the tumour cells does not appear to have an impact on prognosis.

 

GBM Treatment Options

  • The standard of care in first line setting relies on maximal safe tumour resection (removal) followed by radiotherapy with concurrent and adjuvant chemotherapy with temozolomide (Stupp protocol).

  • MGMT promoter methylation is a predictive factor of response to temozolomide. Temozolomide is an alkylating agent able to cross the blood brain barrier because of its small size and lipophilic properties.   

  • In specific subgroups of GBM patients Lomustine or tumour treating fields can be prescribed.