Glioblastoma treatments can now target specific weak points in tumor and cancer cells. For example, low-grade brain tumors can be treated with surgery alone, but high-grade tumors often need radiation and medication after surgery.
“Tumor grade helps us understand how urgently and aggressively the tumor should be treated,” says Feldman.
Multipronged Approach
For a grade 4 glioblastoma, many people need surgery to remove as much of the tumor as possible.But other therapies are usually needed. “Because GBM cells infiltrate the surrounding brain tissue, surgery alone cannot eliminate every tumor cell,” says Feldman.
Depending on the grade, you may need radiation or radiation plus chemotherapy, says Peereboom.
Targeted Treatment Based on Molecular Testing
Molecular testing can help your provider choose targeted treatments. For example, if you have the IDH gene mutation, you may get a medication called vorasidenib (Voranigo), which targets that mutation.
Other Factors Guiding Glioblastoma Treatment
While doctors rely on tumor grade to help determine an appropriate care plan, it’s not the only factor. “We do not treat a number in isolation,” says Bindra, who adds that treatment recommendations also depend on:
- Your age and overall health
- Symptoms
- Tumor location
- How much tumor can be safely removed
- Individual preferences and goals
“Treatment decisions should be personalized and made by a multidisciplinary team experienced in caring for patients with brain tumors,” says Feldman.
Clinical Trial Options Based on Grading
Most clinical trials require molecular testing to join. “For instance, a clinical trial eligibility criteria might say something like, ‘This trial is open for patients who have MGMT,’” says Peereboom.
Feldman recommends considering clinical trials early on, not just after other treatment options fail. When you join a clinical trial, you can receive new medications that aren’t available to the public.
“The pace of research in brain tumors has accelerated substantially, with advances in molecular classification, targeted therapies, immunotherapy, novel drug delivery approaches, radiation techniques, and treatments designed around specific genetic vulnerabilities in the tumor,” says Bindra.
With new information learned through clinical trials, experts are developing more precise treatments, says Bindra. “I am optimistic that these advances will continue to improve outcomes for patients,” he says.
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