Experimental Treatments For Glioblastoma

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The state-of-the-art treatments for glioblastoma fall far short of what oncologists would like to offer their patients, though outcomes are gradually improving. The median length of survival in the 1990s was 8 to 10 months. Only a few patients lived five years. Now the median length of survival is 15 to 18 months — twice what it was 20 years ago.

A variety of experimental treatments are also now under study. These treatments offer the hope of a much better future for patients with glioblastoma.

Why Is Glioblastoma So Hard to Treat?

Some of the potential options were discussed recently by Mark Gilbert, MD, a senior investigator and chief of the National Institutes of Health’s (NIH) Neuro-Oncology Branch. He was joined by Terri Armstrong, PhD, a senior investigator at the NIH. The Neuro-Oncology Branch is a joint program of the National Cancer Institute (NCI) and the National Institute of Neurological Disorders and Stroke.
Before describing the experimental treatments, Dr. Gilbert and Dr. Armstrong explained why glioblastoma is so hard to treat. There are three main reasons:

First, the brain ...
... denies entry to many chemicals — including potential treatments — with the blood-brain barrier, a network of capillaries that governs what reaches the brain. That’s generally a good thing; it protects the brain from toxins and infections. But it becomes a problem when researchers want to get certain chemicals into the brain.

Second, glioblastoma tumors are made up of different kinds of cells, some of which respond to chemotherapy drugs, and some of which don’t.

Third, the brain rests like a stiff pudding inside a hard, closed shell. Some chemotherapy drugs cause the brain to swell, and that can be dangerous, because there is no place for the brain to expand into. Swelling can compress tissue and lead to death of brain cells.

What Are the Current Treatments for Glioblastoma?

“Surgery within a few days of imaging or of presenting symptoms — to remove as much of the tumor as possible — is the first treatment for the majority of glioblastoma patients,” Gilbert says. And “after surgery, patients generally receive a 30-dose course of radiation over a six-week period and daily treatment with the chemotherapy drug Temodar (temozolomide) to treat malignant cells that couldn’t be removed with surgery.”

The problem is that even if a surgeon removes every visible trace of the tumor, the scattered few cells that remain continue to grow. Surgery, therefore, can slow the tumor growth, but not stop it. These treatments “rarely cure the cancer, because of microscopic tumors that remains after surgery,” says Armstrong.