|Perspectives In Central Nervous System Malignancies|
Stuart A. Grossman, MD,* Martin J. van den Bent, MD, PhD,† and W. K. Alfred Yung, MD‡
The detection and management of gliomas remains one of the most challenging areas in medicine. Despite the introduction of several newer diagnostic techniques and various multimodal forms of therapy, the prognosis for these deadly tumors has remained largely unchanged over the past 3 decades.
Today we are on the verge of many exciting scientific and clinical breakthroughs in the care of patients with gliomas. Results of preclinical and ongoing clinical trials have demonstrated the value of new techniques for diagnosis and follow-up assessment, along with new treatment methods. Newer imaging techniques can help the clinician distinguish true progression from pseudo-progression, thereby avoiding unnecessary surgery and chemotherapy.
The introduction of temozolomide as adjuvant therapy to the standard regimen of surgery and radiation in patients with glioblastoma has yielded a significant and clinically relevant survival advantage that provides a standard of comparison for future research. Studies are under way to determine the role of temozolomide treatment in anaplastic and low-grade gliomas. Potential targets for other drug treatments are the receptors for endothelial growth factor and tyrosine kinase and phosphoinositide (PI) 3 kinase inhibitors. Preliminary studies with these drugs have shown varying response rates, but further research is indicated.
Classifying the heterogeneity within tumor types should lead to the identification of gene markers to determine how tumors will respond to particular treatments, aiding in the development of individualized patient treatment plans. The study of tumor vasculature will help to identify the various antitumor effects of anti-angiogenesis agents, improving the efficacy of these agents. Preliminary research has assessed the influence of CD4 counts on survival in patients with high-grade gliomas.
Advances in the understanding of immunology are being used to elucidate the role of immunologic factors in the development and progression of gliomas. Trials of immunotherapy have shown promising survival times when patients are vaccinated with mature dendritic cells derived from the resected tumor. The establishment of large multicenter clinical trials of immunotherapy will provide valid and reliable information that is expected to lead to better patient care and increased survival.
This issue of Johns Hopkins Advanced Studies in Oncology includes summaries of presentations from the PCNSM4: Perspectives in Central Nervous System Malignancies conference held on March 28-29, 2008, in Berlin, Germany. The annual PCNSM conference is developed and managed by Imedex®. Matthias Preusser, MD, from the Medical University of Vienna, discussed optimal approaches to assessing methylguanine methyltransferase expression. Martin J. van den Bent, MD, PhD, and Walter Taal, MD, both from the Daniel den Hoed Cancer Center at Erasmus University Medical Center, reviewed new data on tumor "pseudo-progression", offering suggestions about how to improve the diagnosis of true progression. W. K. Alfred Yung, MD, from the MD Anderson Cancer Center, reviewed the molecular aspects of glioblastoma, explaining the rationale for the development of PI3 kinase inhibitors. Stefaan Van Gool, MD, PhD, from University Hospital Gasthuisberg, provided encouraging survival data achieved by processing tumor cells and using the product as a vaccine against gliomas. And finally, Brigitta G. Baumert, MD, PhD, from Maastricht University Medical Center, reviewed the value of re-irradiation after early failure of local treatment in high-grade gliomas, noting which techniques are most appropriate. These summaries were identified by the conference chairs, Dr van den Bent and Dr Yung, to provide neuro-oncologists and radiation oncologists with some of the most up-to-date information regarding the diagnosis, management, and treatment of patients with central nervous system malignancies.
*Professor, Oncology, Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
†Professor, Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
‡Chairman, Department of Neuro-Oncology, Margaret and Ben Love Chair of Clinical Cancer Care, MD Anderson Cancer Center, Houston, Texas.
Address correspondence to: Stuart A. Grossman, MD, Professor, Oncology, Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, MD 21231. E-mail: email@example.com.
The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his or her article and all its contents.