Brain Cancer Experts Behind the Scenes at the Abramson Cancer Center

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2012- Focus on Brain Cancer Conference. In this blog, she discusses the experts behind the scenes at the Abramson Cancer Center.

"For 10 years, we have been talking more about hope than progress, but in the last couple of years, we are seeing big differences using new drugs and targeted therapies. We aren't really sure why this is occurring, but we know that our mission is to move from discovery to recovery."- Steven Brem, MD, Conference Chair, and Director of Neurosurgical Oncology.

In 2012, 23,000 people will be diagnosed with cancers of the brain and spinal cord. In adults, 75 percent of those will be glioblastomas.

Cancer treatment today depends on having a team of experts, working together, pooling their knowledge and insight to develop the best care plan for every individual patient. Patients get to know their surgeons and medical oncologists, even their radiation therapists, but seldom interact with other members of the team whose contributions are critical.

The Focus on Brain Cancer Conference offered patients and family members the opportunity to hear from those experts, the pathologist, the radiologist, and in this instance, a scientist who works with mathematical models to understand brain cancer. Their talks were a clear indication of the progress being made in understanding brain cancers--advances that translate directly into improvements in treatment.

Pathologists Identify Genetic Subtypes of Brain Cancers

Maria Martinez-Lage, MD, opened the conference by explaining the information that pathologists use to identify and classify brain cancers. She noted that brain cancers are not staged like other cancers, but rather assigned a grade from I to IV, with four being the most common and most aggressive adult brain tumor, glioblastoma. She also noted that glioblastoma is no longer viewed as one disease--rather there are four subtypes characterized by different molecular profiles.

Pathologists now look for several key factors in diagnosing and categorizing glioblastomas. These include:

• IDH1 mutation: A gene mutation that occurs more often in lower grade tumor and indicates a favorable prognosis
• MGMT: A genetic mutation that occurs in some glioblastomas that is an indicator or whether a tumor will respond to chemotherapy
• ECFRvIII : A gene mutation found in some glioblastomas and other cancers that indicates a more aggressive tumor--but also responds to specific targeted therapy

This kind of information has a direct impact on the treatment decision-making process. Research is currently underway to find other genetic mutations that can be targeted. Penn has also opened a Center for Personalized Diagnostics a combined research and patient care facility that is focused on the next generation of gene sequencing for cancer.

The cause of glioblastoma is generally unknown. There are some very rare familial syndromes that increase the risk, and some association with toxins and high doses of ionizing radiation, but most cases occur without an identifiable cause.

Watch a video about how the Center for Personalized Diagnostics is changing the way tumors are targeted.

Radiologists Pinpoint Critical Differences in Tumors

MRIs are the mainstay of brain cancer diagnosis and treatment assessment--a reality illustrated by the fact that the great majority of patients at the Penn Medicine Conference have had 10 or more MRIs. MRIs provide more information than CT scans without using radiation. According to Ronald Wolf, MD,PhD new approaches to imaging, however, are yielding rich new information about biology, anatomy and functioning of brain cancers that is changing treatment for many patients. These include:

• Angiogenesis: The formation of blood vessels by the cancer
• Cellularity: The cellular composition of the tumor
• Metabolism: The rate at which the tumor is consuming nutrients
• Anatomy: The exact shape and location of the tumor

Why are these important? These factors help predict how the tumor will behave. A brain cancer with a high tumor blood volume, for example, is generally higher grade and more aggressive than those with lower blood volume. They are also more likely to be the tumors that are positive for the EGFRvIII mutation.

Powerful imaging tools also allow for more precise "mapping" of specific areas of brain, those that control motor skills or language--which guide the surgeon in removing as much of the tumor while sparing normal tissue.

"These new tools," says Dr. Wolf, "give us a more accurate clinical profile, which allow us to tailor treatment decisions to the individual."

"The Big Tent": Science and Medicine Today: Engineers, Physicists and Mathematicians for Brain Cancer Treatment

Most cancer patients don't think of engineers, physicists and mathematicians as having anything to do with their treatment, but today's medicine often involves scientists from a broad range of disciplines. Christos Davatzikas, Ph.D., is one of them, an engineer at Penn, who is developing sophisticated mathematical models of the location, grade, type and size of glioblastomas to help understand more precisely how these tumors grow. His analysis provides critical data that helps predict which brain cancers will recur. One key finding confirmed by Davatzikas's data is that certain parts of the brain are more likely to develop high grade, aggressive tumors than others.

"We are using this information to inform clinicians as well as patients," he says. " If we can predict recurrence, we can provide more effective therapy to patients who need it and stop ineffective therapy for patients who are not benefitting from it."