Brain Tumors

From the Physician’s Desk 
. . .an Interview with Dr. Andrew B. Lassman and Dr. Tony J.C. Wang

Andrew B. Lassman, MD, is the John Harris Associate Professor of Neurology and the Chief of Neuro-Oncology at Columbia University Medical Center, and also serves as the Medical Director for the Clinical Protocol Data Management Office of the Herbert Irving Comprehensive Cancer Center. His clinical practice is limited to central nervous system tumors and metastases.

Tony J. C. Wang, MD, is the Co-Director of the Center for Radiosurgery and an Associate Professor of Radiation Oncology (in Neurological Surgery) at New York Presbyterian/Columbia University Medical Center. Dr. Wang cares for patients with all types of cancer, with extensive expertise in malignant and benign brain tumors. His research interests are in Gamma Knife stereotactic radiosurgery and brain tumors.

There are two conceptual classes of brain tumors: primary brain tumors, which begin in the brain and rarely move outside the brain, and metastatic tumors, those that have spread to the brain from a different type of primary cancer, such as lung cancer or breast cancer. Although they can have similar effects on a person, the treatments used are typically different. In this article, Dr. Lassman and Dr. Wang, colleagues at Columbia University and co-chairs on an international brain tumor clinical trial, discuss treating primary brain tumors.

According to Dr. Lassman, when people learn they have a brain tumor, the first thing they typically want is information.

“Sometimes people request an appointment before we have all of the details available,” he said, “but that’s understandable. They are distressed about their diagnosis, and they want to know what they have, what it means and what they should do. My goal is to answer those questions for them.”

As part of that initial meeting, Dr. Lassman talks about the standard, or first-line, therapy available. He also often introduces clinical trials as a treatment option.

“Glioblastomas are the most common type of primary brain tumors in adults, and they are also the most aggressive. Although the standard treatment we have can be very effective, it isn’t always as effective as we want it to be. Therefore, we often consider clinical trials.”

When he introduces the concept of a trial to patients, he explains that, by definition, a clinical trial is experimental.

“It may be better, it may be worse, or it may be the same with more side effects. If we knew it were better, it would already be the standard treatment. If we knew it were worse, we wouldn’t do it. But, simply doing a clinical trial gives us hope that we will find a better treatment.”

“It’s important to explain that clinical trials come in different types and different flavors,” he said. “Because of the aggressive nature of glioblastomas, most clinical trials for newly diagnosed disease include the standard therapy as well as the experimental therapy — not one or the other. Ensuring patients understand this helps clear up the common misconception that a patient would be receiving something that is instead of an established effective therapy.”

When meeting with patients, Dr. Lassman also discusses the benefits of participating in a trial, such as receiving a higher level of care. More monitoring by a larger medical team, which includes the research team as well as a neuro-oncologist, medical oncologist, radiation oncologist, neurosurgeons, pathologists, radiologists and more, takes place because of the protocols that must be followed in every clinical trial. Studies suggest that participants of a clinical trial are associated with better outcomes regardless of the type of treatment they receive because of that more intense care.

“There are more eyes on the patient,” he said, “which means side effects or other problems can be noticed and addressed earlier.”

Because radiation therapy is one of the main pillars of treatment for glioblastoma in standard treatments as well as clinical trials, Dr. Lassman recommends that patients set up a consultation with Dr. Wang and his radio-oncology team during the initial visit. To make it easier for patients, the doctors often try to coordinate so both appointments can be on the same day.

“Glioblastoma patients will almost always see a radiation oncologist for an opinion about radiotherapy,” Dr. Wang explained. “And, almost all patients, with some exceptions, will be offered radiotherapy.”

According to Dr. Wang, radiotherapy for glioblastoma typically comes in the form of external beam radiotherapy. When explaining the recommended therapy to patients, he discusses the pros and cons of the treatment and the data on outcomes. He also discusses the potential side effects, which are usually a concern for patients.

A brain tumor diagnosis is alarming, and patients generally feel that “time is of the essence” and want to begin treatment right away. Although timing is very important, recent research shows there is actually an optimal window to begin each aspect of therapy. For example, it’s important for the patient to have recovered from surgery before beginning radiotherapy, which may take a few weeks.

As leaders in the industry who are involved in both the clinical and research aspects of treating brain tumors, both physicians are optimistic about the potential for advances through clinical trials.

“Trials are becoming more personalized and focused on individual disease characteristics, including biomarkers and mutations,” Dr. Wang said. “Drugs are developed for personalized treatment that may increase the therapeutic ratio for our glioblastoma patients. There has been a great interest in personalized treatment based on individual biomarkers and genetic mutations. Additionally, there have been lots of developments in immunotherapy trials for glioblastoma. I feel that this will continue to grow for years to come.”

“Clinical trials are incredibly important to improve outcomes for not just individuals, but all patients,” Dr. Lassman added. “I think people feel empowered that they’re contributing to society and making the world a better place."

 

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