Neuro-oncology: Novel Devices for the Treatment of High-Grade Glioma: A Closer Look at Focused Ultrasound, Laser Interstitial Thermal Therapy (LITT), and Tumor Treating Fields*
Time: 11:00 AM to 12:30 PM
Description
High-grade gliomas are notoriously difficult to treat and have poor outcomes. Novel therapies are desperately needed to improve outcomes and shift treatment paradigms. While the traditional research focus has been on pharmaceutical development, more recently novel devices have shown promise in treating gliomas and are being actively investigated in clinical trials. Focused ultrasound represents a promising new technique for glioblastoma allowing for penetration into brain tissue and transiently disrupting the blood-brain barrier thereby improving delivery of chemotherapeutic drugs into tumor tissue. The feasibility and safety of focused ultrasound has been shown in clinical trials and therapeutic trials are ongoing to demonstrate efficacy. Laser interstitial thermal therapy (LITT) is a novel technique allowing for tumor ablation in surgically inaccessible regions of the brain. The use of LITT may be associated with improved outcomes when used as a salvage therapy. Lastly, tumor treating fields (TTF) has been demonstrated in a large-scale clinical trial to improve survival in patients with newly diagnosed glioblastoma when used in the adjuvant setting. Ongoing clinical trials seek to capitalize on this improvement by using TTF in the concomitant setting with radiation therapy or in combination with novel therapeutics. Treatment of high-grade glioma with novel devices is at the forefront of therapeutics and results from ongoing clinical trials are eagerly awaited to determine the impact these devices may have on patient outcomes.
Objectives
Describe the role of novel devices in the treatment of high-grade glioma.
Discuss the available evidence and/or lack of evidence for novel devices.
Apply novel techniques to patients with high-grade gliomas and understand when to refer for appropriate device therapies.
Speakers
Focused US for BBB disruption
DescriptionFocused ultrasound is a new therapeutic strategy with many potential applications to treat brain disease. However, the precise manner in which the ultrasound energy is delivered determines the mechanistic effects on brain tissue and cerebral vasculature. This talk will review the modalities of ultrasound action, focusing on those that might be useful to treat brain tumors via blood-brain-barrier disruption for enhanced drug delivery.
SpeakersMedical Comorbidities Potentially Modify Survival of Glioblastoma Patients
DescriptionAge, neurologic performance, extent of resection, and certain molecular markers are known to influence survival of patients with glioblastoma multiforme, but the impact of concurrent medical comorbidities has not been studied. We calculated mean overall survival associated with over 55 distinct medical comorbidities in 868 glioblastoma patients presenting at Rhode Island Hospital between 2005 and 2021. Comorbidities with occurrence > 25 patients were also analyzed pairwise using Cox regression to uncover potential epistatic survival effects. Hypertension, hyperlipidemia, and type-2 diabetes mellitus most strongly reduced survival compared to patients without these conditions, though they were often comorbid. Stroke showed a strong detrimental effect on survival independent of those comorbidities, while hypertension tended to reduce survival in patients with other comorbidities. Obesity and atrial fibrillation had a strong detrimental effect on survival when they occurred together but not separately. Potential mechanisms underlying these observations are discussed.
SpeakersRole of Laser Interstitial Thermal Therapy in Brain Tumors
DescriptionDiscussing the basics of Laser interstitial thermal therapy for treatment of brain tumors. Discussing indications and appropriate patient selection. Literature based review and patient outcomes.
Tumor Treating Fields Treatment Device for Glioblastoma
DescriptionTumor Treating Fields device non-invasively delivers alternating electric fields at 200 kHz to treat glioblastoma. The fields are delivered by transducer arrays applied to the scalp of patients. They are known to disrupt tumor cell mitosis and trigger effectors from both innate and adaptive immune systems to carry out anti-tumor immunity. Clinical efficacy against newly diagnosed glioblastomas has been demonstrated in a randomized phase 3 clinical trial when the device was applied together with chemotherapy after radiation, and this led the FDA approve its use in 2015. Two registration trials in non-small cell lung cancer have resulted in survival benefits.