Brain cancer specialists are emphasizing the critical importance of genomic testing in advancing personalized treatment approaches for patients with both primary brain tumors and brain metastases. This push comes during Brain Cancer Awareness Month, as experts highlight recent breakthroughs and ongoing research that offer new hope for patients.
Dr. Manmeet Ahluwalia, chief scientific officer and chief of medical oncology at Baptist Health Miami Cancer Institute, is urging community oncologists to order comprehensive genomic profiling for all brain cancer patients. "Genomic testing is extremely important for patients with brain tumors, because then that helps us pick up the right drug for our patients," he explains.
Targeted Therapies Transforming Treatment Landscape
The identification of specific genetic alterations through genomic testing has already led to significant treatment advances. NTRK gene fusions, present in approximately 1% of all cancers, occur in 8-13% of patients with parasitic astrocytomas and 1% of glioblastoma patients. FDA-approved drugs targeting these fusions, including larotrectinib (Vitrakvi) and entrectinib (Rozlytrek), have shown benefit in these patient populations.
A major breakthrough came in August 2024 with the FDA approval of vorasidenib (Voranigo) for IDH-mutant gliomas. Dr. Ahluwalia describes this development as transformative: "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."
The significance extends beyond a single treatment option. "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," Dr. Ahluwalia notes.
Clinical Trials: Critical Path Forward
For aggressive brain cancers like glioblastoma, clinical trials often represent the best treatment option. Dr. Ahluwalia points out that temozolomide remains the only approved medical therapy that has demonstrated a survival benefit in glioblastoma patients.
"The best way to treat these patients is by offering them clinical trials," he emphasizes. "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."
Importantly, access to clinical trials has expanded beyond academic medical centers. "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," Dr. Ahluwalia says.
Addressing Common Misconceptions
During Brain Cancer Awareness Month, specialists are also working to address misconceptions about brain cancer. Dr. Ahluwalia notes that brain cancer incidence is increasing, but not necessarily for the reasons people might assume.
"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," he explains. Instead, the rising incidence is attributed to an aging population and improved cancer treatments overall, which have led to longer survival and consequently more cases of brain metastases.
Early Detection and Multidisciplinary Care
Experts emphasize the importance of recognizing potential symptoms of brain tumors, including persistent headaches (especially in the morning), unexplained memory issues, or neurological symptoms like weakness in the arms or legs. While these symptoms are more commonly associated with other conditions, they warrant medical attention when persistent.
For patients diagnosed with brain tumors, multidisciplinary care is essential. "I 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," Dr. Ahluwalia advises.
Innovative Approaches on the Horizon
Looking to the future, researchers are exploring novel methods to overcome one of the greatest challenges in brain cancer treatment: delivering drugs across the blood-brain barrier. Dr. Ahluwalia highlights promising work with Insightec, a company developing ultrasound technology to disrupt the blood-brain barrier and potentially enhance drug delivery.
"We are living in the best era of mankind, where we are devising new treatments and new equipment," Dr. Ahluwalia says. "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."
As Brain Cancer Awareness Month continues, the medical community remains focused on advancing research, improving treatment options, and ultimately transforming outcomes for patients with these challenging diagnoses. The integration of genomic testing into standard care represents a crucial step toward more personalized and effective brain cancer treatment strategies.
