Dr. Edward Pan on Treating Brain Tumors

Q:

Why would a brain tumor patient want to be in a clinical trial instead of getting standard treatment? 

A:

For a patient with a malignant brain tumor, many times the current treatment options we have are just not good enough with regards to improving survival and quality of life. Clinical trials offer these patients access to developing drugs that may work. A lot of patients think that being in a clinical trial means being a guinea pig. But they often have very dismal prognoses, and if we don’t try something different, or try to understand the biology better, or understand why drugs are not working, then we will never be able to offer them anything substantial. We’re obviously going to learn something from a clinical trial, but hopefully it will benefit the patient, as well.

Q:

Neuro-oncology is a relatively young specialty. What changes are happening in the field?

A:

Personalized medicine is a major change. The treatments that are standard of care today are general cytotoxic chemotherapies. They’re not targeted; they’re a “hopefully we kill more bad cells than good cells” approach. So aiming to develop therapies tailored to the patient is definitely a change in our thinking.

Another change is that we are thinking about angiogenesis – that is, how cancers build new blood vessels, and how to stop that process in order to stop the cancer. Angiogenesis is known as a target for other cancers, but it’s relatively new in neuro-oncology.

A third change is vaccine trials that try to get your immune system to recognize the brain tumor and fight it. 

Q:

How do you weigh aggressive treatment against quality of life in brain cancer patients?

A:

Any neuro-oncologist understands that quality of life is the most important measure. Everybody wants to live longer; that’s not in doubt. However, in clinical trials, we try to improve quality of life, or at least extend reasonable quality of life for as long as possible.

Doctors used to be a lot more fatalistic when you had a glioblastoma multiforme (the most common and most malignant brain tumor) diagnosed. There was virtually no effective treatment, so a lot of physicians just said, “I’m sorry, there’s nothing for us to do; you might as well make yourself comfortable.” The idea of really putting in an effort, putting resources into trials, and saying “We’re not going to accept that we can’t do anything about it” – that’s a huge shift. There is more hope now.