Hope on the Horizon: Brain Cancer Advances in Awareness Month
Manmeet Ahluwalia, MD, MBA, FASCO, discussed the importance of Brain Cancer Awareness Month for a community oncologist audience.
Manmeet Ahluwalia, MD, MBA, FASCO
May is Brain Cancer Awareness Month, a time to highlight that brain cancer, both primary and metastatic, is common and increasingly manageable with early detection and evolving treatments.
Advancements like the FDA approval of vorasidenib (Voranigo) in August 2024 for IDH-mutant gliomas1 and further understanding of the importance of genomic testing to identify actionable mutations, such as NTRK fusions, have been key points of progress in this space. Manmeet Ahluwalia, MD, MBA, FASCO, highlighted some of these key updates in an interview with Targeted OncologyTM.
“This journey of vorasidenib in IDH-mutant gliomas has been the first example in brain tumors of such a story. I could not be more thrilled about this additional therapy for our patients with those tumors. Also, what this does now is give hope to other genomic alterations and [will help] design new drugs that will go to the brain, which can help our other patients with brain tumors,” Ahluwalia, chief scientific officer, chief of medical oncology, deputy director, and Fernandez Family endowed chair in cancer research at the Baptist Health Miami Cancer Institute, told Targeted OncologyTM.
He also emphasized the importance of clinical trials, especially in aggressive cancers like glioblastoma, and explained how referrals to such trials only continue to help advance patient outcomes.
In the interview, Ahluwalia further discussed the importance of Brain Cancer Awareness Month for a community oncologist.
Targeted OncologyTM: What key message do you hope to convey to our community about Brain Cancer Awareness Month?
Ahluwalia: As a brain cancer physician and a physician investigator, I could not be more excited about May being Brain Cancer Awareness Month. To me, Brain Cancer Awareness Month tackles several things. First and foremost, it is to increase awareness about brain cancer. Unfortunately, the 2 types of brain cancers that we see are cancers that arise in the brain, which are called primary brain tumors, and cancers which can spread from the rest of the body to the brain, which is referred to as brain metastases. We have seen an increase in both of those, and there are several reasons for that, but the most important thing, what we want to raise in May is that brain cancer is common, but it is also a cancer that now we can diagnose early, because screenings have improved. We have become better in our detections, we have better treatments for our patients, and we can do more for them, not only in increasing the amount of time they live, so the quantity of life, but also their quality of life.
I could not be more hopeful about the quality of research that is happening in brain cancer. But also, brain cancer [and this month] is important because it continues to emphasize the journey we have had so far, the journey that we are on today, but more important the journey for tomorrow, which brings us to an important aspect of research, which is to continue to advocate for increased research funding, because research funding is so critical to advancing treatments and cures for our patients.
Tumor in brain: © peterschreiber.media - stock.adobe.com
From your perspective as a community oncologist, what are some of the biggest misconceptions about brain cancer that you'd like to address?
Brain cancer is common. It is not uncommon because there are 2 types of brain cancers. One is tumors that arise in the brain, which are primary brain tumors, and we have seen a steady increase in the incidence of patients with brain tumors. There have been a lot of questions about, is this related to cell phone use? That is a common question that comes up to me, and I tell people, there is no concrete evidence that cell phone use increases brain cancer. However, that being said, we are seeing greater incidence of brain tumors because we have an aging population, and cancer is a disease of the old so as people grow older, the incidence of brain tumors increases as well.
Also, because of all the advances we have had in treating our patients with cancer, the incidence of brain metastases has increased. We are seeing more and more of these patients in the clinic, and we do not need to wait for patients to become symptomatic. Sometimes proactive cushioning of patients can help diagnose these patients early. There are certain kinds of cancers like lung cancer and melanoma, where patients are diagnosed with stage IV, we are actually now screening them for incidence of brain mets, even if they are asymptomatic, and that sometimes will help us to find patients earlier with brain metastases, because we also have a lot of different treatment options for them, which is helping our patients live longer.
What are some of the early signs or symptoms of brain cancer that people should be aware of?
The most common signs and symptoms of brain tumors include increasing incidence of headache, especially in the morning. However, headache is also one of the most common symptoms people have in general. So, if you have an occasional headache, do not get alarmed that that would be a brain tumor. But if you have a persistent headache for weeks to months, or something which is especially worse in the morning, do bring it to the attention of your primary care physician who would then explore this more. Also, if people are having memory issues, and there are no good explanations for that, sometimes that can be a symptom of brain tumor. Additionally, a new stroke or losing strength in the arms or legs could be signs, but for a lot of these signs and symptoms, they are much more likely not related to brain tumors. But if you have a sign and symptom which is indicative of a brain dysfunction or brain disease, I always recommend my patients bring it up with their primary care physician, who can then refer to a neurologist. They could then explore these signs and symptoms and often recommend the right kind of imaging if needed, and exclude brain tumors as a reason for those symptoms.
How has the treatment landscape for brain cancer evolved in recent years, and what does this mean for patients in our community?
In the last several decades, although the outcomes, at least for primary brain tumors and especially glioblastoma, may not have changed a whole lot, we have patients who are living longer and with a better quality of life. I want to emphasize this message of hope for our patients. I also emphasize people when they get a brain tumor to seek their treatment at a center which has a neurosurgeon working closely with a radiation oncologist along with a medical neuro-oncologist, because the best care for complex patients [with cancers] like brain tumors, is given in a multidisciplinary manner.
That being said, I would especially want to highlight IDH-mutant gliomas, which tend to occur more in patients with low-grade gliomas. Since I am an adult brain tumor physician, I will refer to those patients. In 2024, we had a targeted drug called vorasidenib that was approved for patients with IDH-mutant low-grade gliomas. I think it was a great treatment, but it also provides hope for further developments in this era of personalized medicine. We have made tremendous improvements in patients with cancer in terms of identifying what genes are driving their cancers and appropriately devising the targeted therapies that will work in those patients. This journey of vorasidenib in IDH-mutant gliomas has been the first example in brain tumors of such a story. I could not be more thrilled about this additional therapy for our patients with those tumors. Also, what this does now is give hope to other genomic alterations and [will help]design new drugs that will go to the brain, which can help our other patients with brain tumors.
What are some of the current and future areas of research in brain cancer that you find particularly promising?
For patients, make sure you talk to your provider and [for] community oncologists, make sure that you order genomic testing for all your patients with brain tumors, because there are alterations which do occur in brain tumors which could be present in other tumors too. We can take advantage of those drugs. I give an example of NTRK gene fusion, which is present in 1% of all cancers, but is present in 8% to 13% of patients with parasitic astrocytomas and 1% of patients with glioblastoma. We have several drugs like larotrectinib [Vitrakvi] and entrectinib [Rozlytrek], which are approved for these patients, and they do tend to benefit from these agents. Genomic testing is extremely important for patients with brain tumors, because then that helps us pick up the right drug for our patients, but also, if there are no good standard-of-care treatments for those patients, we can then offer clinical trials.
Another thing that I would love to emphasize is the importance of clinical research in devising new treatments for our patients, because a lot of times, especially for those with brain cancer, and I will take example of glioblastoma, we only have 1 approved medical therapy that has shown to increase survival benefit in those patients. It is a drug called temozolomide. While we have several other approved therapies, at least medical therapies, they do not increase survival. The best way to treat these patients is by offering them clinical trials. If you do not have a clinical trial at your place, then refer them to the nearest [and largest] center that may have access to clinical trials. The beauty is now that these clinical trials are not only available at academic centers, but sometimes they are available at large community practices as well. Having access to clinical trials is so much more important for tumors like glioblastoma, where the best way to treat these patients is on a clinical trial, if the patients are eligible.
What is something you want people to understand about brain cancer during this awareness month?
I would like to emphasize the hope and excitement for the future. As a brain cancer researcher, I could not be more excited about the future for our patients, because we are living in the best era of mankind, where we are devising new treatments and new equipment. One of the challenges in brain cancer over the years has been our ability to deliver the drugs to the brain. We have been working with a company called Insightec, which uses a disruption system using ultrasound to disrupt this lining around the brain called blood-brain barrier, and with that, we may be able to deliver drugs in a greater manner to our patients with brain tumors, which opens up new avenues for research and improved outcomes for these patients. I would like to re-emphasize this message of hope for both our patients and their caregivers, but also physicians taking care of these patients.
