Brain Cancer Awareness Month 2022

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:07Welcome to Yale Cancer
00:07 --> 00:09Answers with your host
00:09 --> 00:11Doctor Anees Chagpar. Yale Cancer
00:11 --> 00:13Answers features the latest information
00:13 --> 00:15on cancer care by welcoming oncologists
00:15 --> 00:18and specialists who are on the
00:18 --> 00:20forefront of the battle to fight cancer.
00:20 --> 00:20This week,
00:20 --> 00:22it's a conversation about the
00:22 --> 00:24care of patients with brain tumors
00:24 --> 00:26with Doctor Nicholas Blondin. Dr
00:26 --> 00:28Blondin is an assistant professor
00:28 --> 00:29of clinical neurology at the
00:29 --> 00:31Yale School of Medicine,
00:31 --> 00:34where Doctor Chagpar is a professor
00:34 --> 00:35of surgical oncology.
00:35 --> 00:36So maybe
00:36 --> 00:39we can start by you telling us a little
00:39 --> 00:41bit more about what it is you do and
00:41 --> 00:44and a bit more about yourself.
00:44 --> 00:47Well, sure, I'm neurologist by training
00:47 --> 00:49and following my neurology residency
00:49 --> 00:53I did some additional training in oncology
00:53 --> 00:56and so I finished with board certification
00:56 --> 00:58and neurology and Neuro Oncology.
00:58 --> 01:00And so I approach patient care
01:00 --> 01:03as a neurologist thinking about
01:03 --> 01:04Neurological function of my
01:04 --> 01:07patients and how their body works.
01:07 --> 01:08But now we're in practice,
01:08 --> 01:10really full time and
01:10 --> 01:13see patients affected by brain tumors
01:13 --> 01:16and cancer causing neurological symptoms.
01:17 --> 01:19So let's talk a little bit
01:19 --> 01:21about both of those areas.
01:21 --> 01:24So first, in terms of brain cancers,
01:24 --> 01:25can you give us a little bit
01:25 --> 01:27more of the lay of the land?
01:27 --> 01:28Who gets brain cancer?
01:28 --> 01:30What are the different types?
01:30 --> 01:32How? How do we kind of approach
01:32 --> 01:33thinking about brain cancers?
01:34 --> 01:37Sure, well on the one sense.
01:37 --> 01:39Fortunately, brain tumors and
01:39 --> 01:42brain cancer is a rare condition.
01:42 --> 01:45It's felt to have kind of a incidents
01:45 --> 01:49or diagnosis rate of approximately 300
01:49 --> 01:52people per 1,000,000 people per year.
01:52 --> 01:55There are two subtypes of brain tumors,
01:55 --> 01:57those being considered benign brain tumors
01:57 --> 02:00or noncancerous and those being cancerous,
02:00 --> 02:02meningiomas and glioma tumors are
02:02 --> 02:05the most common tumors in in patients
02:05 --> 02:07that constitutes approximately 2/3
02:07 --> 02:11of all all the brain tumors and the
02:11 --> 02:14frequency of these tumor types and
02:14 --> 02:16their grade varies by their age group,
02:16 --> 02:19so brain tumors can actually affect
02:19 --> 02:21a person at any age from infants
02:21 --> 02:22and young children.
02:22 --> 02:23All the way through our very,
02:23 --> 02:27very elderly patients and brain
02:27 --> 02:30tumors are amongst children,
02:30 --> 02:33a relatively common childhood cancer
02:33 --> 02:36following leukemia in adults.
02:36 --> 02:37Brain metastasis,
02:37 --> 02:38which is the spread of other
02:38 --> 02:39cancers to the brain,
02:39 --> 02:43is more common than primary brain tumors.
02:44 --> 02:46Glioblastoma is the most common malignant
02:46 --> 02:48primary brain tumor in adults and
02:48 --> 02:51becomes more common with older age,
02:51 --> 02:53particularly for folks in their 60s or 70s.
02:55 --> 02:56Wow, lots to unpack there,
02:56 --> 02:59so let's start at the beginning.
02:59 --> 03:01When you talked about brain tumors.
03:01 --> 03:02Kind of affecting everyone
03:02 --> 03:04throughout the age spectrum.
03:04 --> 03:06One of the things that I think
03:06 --> 03:08many of our listeners might be
03:08 --> 03:10really intrigued about is the fact
03:10 --> 03:12that brain tumors are so common
03:12 --> 03:14in young infants and children.
03:14 --> 03:17Tell us a little bit more about how that
03:17 --> 03:20presents who might be at greatest risk,
03:20 --> 03:22and you know, certainly when parents
03:22 --> 03:25hear that statistic that you mentioned.
03:25 --> 03:27They may be curious about what to look for
03:27 --> 03:30in terms of brain cancers in their children.
03:30 --> 03:32Can you shed some light on that?
03:33 --> 03:36Sure. Well, I guess I would like to correct.
03:36 --> 03:39In one sense, they're a common cancer,
03:39 --> 03:41but fortunately cancers are
03:41 --> 03:42extremely rare in children,
03:42 --> 03:46so they are, you know.
03:46 --> 03:47Overall, for children,
03:47 --> 03:49like very rare conditions,
03:49 --> 03:51typically they would be discovered
03:51 --> 03:54by a patient or like a child
03:54 --> 03:56having difficulty with walking like
03:56 --> 03:59unexplained falls or headaches and
03:59 --> 04:01like kind of cognitive impairments
04:01 --> 04:04or sudden changes leading you know,
04:04 --> 04:06to initially like evaluation
04:06 --> 04:09and diagnosis via imaging.
04:09 --> 04:11You know, finding a brain tumor.
04:12 --> 04:14And so so you know, if you have
04:14 --> 04:16a child who might be a little
04:16 --> 04:18bit delayed, might be falling.
04:18 --> 04:20Might be complaining of headaches,
04:20 --> 04:22something to go and talk to your
04:22 --> 04:24pediatrician about. Is that right?
04:24 --> 04:26Yeah, that's that's for sure.
04:26 --> 04:28I mean parents. You know,
04:28 --> 04:29they know their kids the best,
04:29 --> 04:32and if they see a change.
04:32 --> 04:34And it's anything I've concerned
04:34 --> 04:36definitely is most appropriate
04:36 --> 04:38to check in with the pediatrician
04:38 --> 04:40and they'll have a good sense to
04:40 --> 04:41help figure out what's going on.
04:42 --> 04:45And so, how is that diagnosis made?
04:45 --> 04:47You go in? You see the pediatrician.
04:47 --> 04:48The pediatrician says, yeah,
04:48 --> 04:50you know this is kind of odd for your child.
04:50 --> 04:52I agree there might be something going on.
04:52 --> 04:55What's the next step is the next step
04:55 --> 04:58imaging and after that what happens is?
04:58 --> 05:00Is there a biopsy involved?
05:01 --> 05:05Well, I think that the pediatrician would,
05:05 --> 05:08you know here here the the history
05:08 --> 05:09and the situation and then
05:09 --> 05:12examine the child if they see any.
05:12 --> 05:14Concerning neurological signs
05:14 --> 05:18like difficulty with walking.
05:18 --> 05:20Other just neurological
05:20 --> 05:22anomalies on the test.
05:22 --> 05:24They may want to refer the patient
05:24 --> 05:26to a pediatric neurologist,
05:26 --> 05:30or they they may want to just
05:30 --> 05:33proceed with doing an imaging test.
05:33 --> 05:33In children,
05:33 --> 05:35and even really in adults,
05:35 --> 05:37doing Mris may be preferable
05:37 --> 05:40to doing CAT scans as MRI is a
05:40 --> 05:42technology based on magnets,
05:42 --> 05:44whereas CAT scans it's a low dose
05:44 --> 05:46of radiation and you want to try to
05:46 --> 05:48limit radiation in in in children,
05:48 --> 05:50if at all possible, yeah,
05:50 --> 05:53then if if some abnormalities found
05:53 --> 05:55on the imaging then the patient
05:55 --> 05:58would be while he referred to a
05:58 --> 06:00neurosurgeon for their expertise
06:00 --> 06:03and figuring out what could be the.
06:03 --> 06:05The next steps going forward,
06:05 --> 06:07whether it's just further monitoring
06:07 --> 06:09with scans or whether doing like
06:09 --> 06:10a biopsy or a neurosurgical
06:10 --> 06:11procedure is indicated.
06:13 --> 06:15How would how would the
06:15 --> 06:16neurosurgeon determine that?
06:16 --> 06:19If you see a lesion on the MRI,
06:19 --> 06:21how would they determine whether
06:21 --> 06:23that's something that they can
06:23 --> 06:24just watch and follow with?
06:24 --> 06:26You know serial scans,
06:26 --> 06:28or whether that's something
06:28 --> 06:30that needs to be biopsied or
06:30 --> 06:34potentially removed well with.
06:34 --> 06:38Imaging there can be appearances
06:38 --> 06:40of abnormalities that.
06:40 --> 06:42Have a look of like some a malignancy
06:42 --> 06:45or or a concerning lesion and then
06:45 --> 06:47other things that look like non
06:47 --> 06:49concerning lesions and that really is
06:49 --> 06:51just expertise with time and medical
06:51 --> 06:53training to like understand what we're
06:53 --> 06:57really looking at on the scans and.
06:57 --> 06:58It's like attending physicians
06:58 --> 06:59say they would.
06:59 --> 07:00They would know like this.
07:00 --> 07:02Looks like something we need to deal with,
07:02 --> 07:04like and and really diagnose or.
07:04 --> 07:05On the other hand, no.
07:05 --> 07:08This looks like just a benign kind
07:08 --> 07:10of a lesion, and it would really be
07:10 --> 07:13safer just to monitor this with scans.
07:13 --> 07:14Beyond, yeah, Pediatrics said.
07:14 --> 07:16This is a really a just a key
07:16 --> 07:17component of my practice as well.
07:17 --> 07:19I see patients all the time with
07:19 --> 07:21with abnormal scans and they do
07:21 --> 07:23fall into those two categories
07:23 --> 07:25and I love seeing the patients
07:25 --> 07:27where I know the the scan.
07:27 --> 07:27Actually,
07:27 --> 07:30as it looked really of a benign nature,
07:30 --> 07:32you know not consistent with
07:32 --> 07:34cancer or malignancy and that's
07:34 --> 07:35great news to give a person
07:36 --> 07:39so it's a really based on on the
07:39 --> 07:41imaging characteristics of of the
07:41 --> 07:43lesion in mind and and then you
07:43 --> 07:46said that you know in adulthood.
07:46 --> 07:49Brain cancers can also occur most commonly
07:49 --> 07:53in patients who are in their 60s or 70s.
07:53 --> 07:58So how might those symptoms present?
07:58 --> 07:59How do patients present with
07:59 --> 08:01brain tumors when they're older?
08:03 --> 08:05A warning sign for a brain tumor
08:05 --> 08:08in adults is a first time seizure
08:08 --> 08:10in a person without a previous
08:10 --> 08:12history of seizures or epilepsy.
08:12 --> 08:15That's a common way that.
08:15 --> 08:18A person can be found to have a brain tumor,
08:18 --> 08:21other relatively common of ways
08:21 --> 08:24of diagnosing it as someone with,
08:24 --> 08:26like a rapid onset over
08:26 --> 08:27weeks of of confusion,
08:27 --> 08:30or most seeming like dementia
08:30 --> 08:31and cognitive impairments,
08:31 --> 08:34or if someone develops a visual loss,
08:34 --> 08:37a loss of part of their field of vision.
08:37 --> 08:39I've seen some folks that end up
08:39 --> 08:41having a car accidents where where
08:41 --> 08:43they don't realize they've lost
08:43 --> 08:45some some vision or eye doctors.
08:45 --> 08:46And you know,
08:46 --> 08:48detect a patient has a partial
08:48 --> 08:50visual field loss and refer the
08:50 --> 08:52patient to a neurologist with a scan,
08:52 --> 08:53then showing a brain tumor.
08:55 --> 08:58And then same kind of algorithm in
08:58 --> 09:01terms of getting scans and determining
09:01 --> 09:03based on the imaging characteristics.
09:03 --> 09:05Whether this looks benign or malignant.
09:06 --> 09:09Exactly we can tell based
09:09 --> 09:12on scan the scan findings.
09:12 --> 09:14Have a good differential for what
09:14 --> 09:16that lesion could be and whether it
09:16 --> 09:19you know needs to have a biopsy or
09:19 --> 09:22or neurosurgical intervention or not.
09:23 --> 09:28And so you know you mentioned that.
09:28 --> 09:31Tumors of the brain are are really
09:31 --> 09:33classified into benign and malignant.
09:33 --> 09:35So what proportion of brain cancers
09:35 --> 09:38are benign and what proportion
09:38 --> 09:41are malignant and does that vary
09:41 --> 09:43between children and adults?
09:44 --> 09:49It does vary vary between.
09:49 --> 09:50Between children and adults.
09:50 --> 09:53In terms of what tumors
09:53 --> 09:55tumors can occur in children.
09:55 --> 09:56Tumor, called a medulloblastoma
09:56 --> 09:58is is the common malignant tumor,
09:58 --> 09:59whereas those are rare
09:59 --> 10:01in adults and in adults.
10:01 --> 10:02Glioblastoma is the most
10:02 --> 10:03common malignant tumor,
10:03 --> 10:05and those are rare in children.
10:05 --> 10:05Meningiomas,
10:05 --> 10:08which are a benign type of tumor
10:08 --> 10:11are extremely rare in children,
10:11 --> 10:12but they are the most common
10:12 --> 10:13brain tumor in adults,
10:13 --> 10:16and they're considered benign in
10:16 --> 10:18that they grow relatively slowly.
10:18 --> 10:20They actually grow on the lining
10:20 --> 10:22of the brain, called the dura,
10:22 --> 10:24and cause issues by causing
10:24 --> 10:27compression on the brain as they grow.
10:27 --> 10:29So even though they typically
10:29 --> 10:32don't invade the brain as an
10:32 --> 10:35organ directly and grow slower.
10:35 --> 10:37They still can cause significant
10:37 --> 10:37neurological problems,
10:37 --> 10:41including seizures and epilepsy, and.
10:41 --> 10:46So terming them benign may not really,
10:46 --> 10:47you know, really.
10:47 --> 10:49Look at the whole scope of of
10:49 --> 10:50how that's impacting a person.
10:50 --> 10:53Yeah, benign, but still problematic.
10:53 --> 10:55So what proportion of brain tumors
10:55 --> 10:58in children are benign versus what
10:58 --> 11:00proportion are malignant? Roughly,
11:01 --> 11:03I think that the again the tumors are rare,
11:03 --> 11:06but it may actually be kind of like a like.
11:06 --> 11:09A kind of an even split as some
11:09 --> 11:11tumors are called pilocytic Astro.
11:11 --> 11:13Hey Tomas, that can be cured with
11:13 --> 11:16surgery and it considered benign.
11:16 --> 11:18That's another relatively common
11:18 --> 11:20tumor of children that we really
11:20 --> 11:22don't see very often in in adults.
11:23 --> 11:26And for adults are benign tumors
11:26 --> 11:28more common than malignant?
11:28 --> 11:29They are ten.
11:29 --> 11:32Yeah, there there is, uh, like an.
11:32 --> 11:35Increase in the benign tumors compared
11:35 --> 11:37to compared to the malignant.
11:37 --> 11:40Again with meningiomas being the
11:40 --> 11:43most common and pituitary tumors
11:43 --> 11:46are another form of a benign brain
11:46 --> 11:47tumor that's relatively common
11:47 --> 11:50and may be able to be managed
11:50 --> 11:52with a hormonal medication.
11:53 --> 11:56And so, in the malignant you classified
11:56 --> 11:58the malignant further into brain
11:58 --> 12:00tumors that start in the brain.
12:00 --> 12:02And we've talked a little bit
12:02 --> 12:04about some of those and secondary
12:04 --> 12:06malignancies or cancers that start
12:06 --> 12:09somewhere else in travel to the brain.
12:09 --> 12:12So when we think about malignant
12:12 --> 12:15brain tumors, which are more common,
12:15 --> 12:17the kind that start in the brain,
12:17 --> 12:19or the kind that travel there
12:19 --> 12:20from somewhere else. Well,
12:20 --> 12:24the the secondary tumors are
12:24 --> 12:26actually much more common.
12:26 --> 12:28Actually, I've felt up to be 10 times
12:28 --> 12:31more common than primary brain tumors.
12:31 --> 12:34Uh, I think really just reflecting that
12:34 --> 12:36other cancers like lung cancer and
12:36 --> 12:39breast cancer in particular are are
12:39 --> 12:42just much more common in adults than
12:42 --> 12:44gliomas and other primary brain tumors.
12:44 --> 12:47If you were diagnosed with another
12:47 --> 12:49kind of cancer, lung cancer,
12:49 --> 12:52colon cancer, breast cancer,
12:52 --> 12:54prostate cancer can all of
12:54 --> 12:55these travel to the brain?
12:55 --> 12:57Or does the brain have
12:57 --> 12:58a certain predilection?
12:58 --> 13:00For some cancers versus others,
13:00 --> 13:02it turns out that there is this
13:02 --> 13:05predilection for some cancers versus others,
13:05 --> 13:08and some rare cancers have a relatively
13:08 --> 13:11high rate of brain involvement,
13:11 --> 13:13such as Melanoma and then other cancers
13:13 --> 13:16have a very low rate of brain involvement,
13:16 --> 13:19like prostate cancer.
13:19 --> 13:21Lung cancer and breast cancer
13:21 --> 13:22may spread to the brain.
13:22 --> 13:25It's estimated to be at up to 1/4 of
13:25 --> 13:28people affected by those cancers.
13:28 --> 13:30Ultimately, and treatments have improved
13:30 --> 13:34for breast and lung cancer over the last
13:34 --> 13:37decade and pay as patients live longer.
13:37 --> 13:40There may be a higher rate of brain
13:40 --> 13:43metastasis that that wasn't seen in the past.
13:44 --> 13:46We're going to have to take a
13:46 --> 13:48short break for a medical minute.
13:48 --> 13:51But please stay tuned to learn more about
13:51 --> 13:52brain tumors and their treatment.
13:52 --> 13:55When we come back after the break with
13:55 --> 13:56my guest Doctor Nicholas Blondin.
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15:14 --> 15:17Welcome back to Yale Cancer Answers.
15:17 --> 15:18This is doctor Anees Chagpar
15:18 --> 15:20and I'm joined tonight by my
15:20 --> 15:22guest Doctor Nicholas Blondin.
15:22 --> 15:24We're talking about the management of
15:24 --> 15:27patients with brain tumors in honor
15:27 --> 15:29of Brain Cancer Awareness Month.
15:29 --> 15:31Now, right before the break,
15:31 --> 15:33Doctor Blondin was telling us that
15:33 --> 15:35brain tumors can affect everyone
15:35 --> 15:37throughout the age spectrum from
15:37 --> 15:40infants and young children all the way
15:40 --> 15:42up to more elderly patients that brain
15:42 --> 15:45tumors can be benign or malignant.
15:45 --> 15:47And of those that are malignant,
15:47 --> 15:49they can either start in the brain or
15:49 --> 15:51they can travel there from somewhere else,
15:51 --> 15:54and that is by far the most common.
15:54 --> 15:57Our brain scans routinely done in
15:57 --> 16:00patients who have been diagnosed with,
16:00 --> 16:02say, breast cancer or lung cancer,
16:02 --> 16:05or Melanoma or prostate cancer.
16:05 --> 16:07Or is that something that is
16:07 --> 16:09only done if they have symptoms?
16:11 --> 16:14It depends again on the type of cancer
16:14 --> 16:18that that a person has been diagnosed with,
16:18 --> 16:21and there are guidelines for various
16:21 --> 16:25cancers in regards to doing screening
16:25 --> 16:29Mris or or not needing to do them with.
16:29 --> 16:31Some lung cancers,
16:31 --> 16:34particularly more advanced lung cancers,
16:34 --> 16:36that that may involve lymph
16:36 --> 16:37nodes in the chest.
16:37 --> 16:40Doing an MRI of the brain and
16:40 --> 16:42following diagnosis is generally
16:42 --> 16:43appropriate and recommended,
16:43 --> 16:47and with other cancers like Melanoma.
16:47 --> 16:49When when they're diagnosed,
16:49 --> 16:52brain scan also is part of the it's
16:52 --> 16:54called the staging evaluation and
16:54 --> 16:57doing a like a evaluation to find
16:57 --> 16:59where could this cancer have gone.
16:59 --> 17:02But in other cancers like breast
17:02 --> 17:05cancer and colon cancer for example,
17:05 --> 17:07it's not done routinely. Is that right?
17:07 --> 17:10That is correct.
17:10 --> 17:12Believe the majority of breast
17:12 --> 17:14cancers are localized in one breast,
17:14 --> 17:17they can be fortunately cured with
17:17 --> 17:19surgery or does with surgery followed
17:19 --> 17:22by radiation or other therapies.
17:22 --> 17:24And in the these patients the chance
17:24 --> 17:26of a brain of tasks is felt to
17:26 --> 17:29be sufficiently low that doing a
17:29 --> 17:32screening brain MRI is not part of
17:32 --> 17:34the these kind of guidelines for for
17:34 --> 17:36evaluation at the time of diagnosis.
17:37 --> 17:41And so for patients who, you know,
17:41 --> 17:44have a cancer and either due to symptoms
17:44 --> 17:48or due to routine screening, have an
17:48 --> 17:50MRI of the brain and a lesion lights up.
17:50 --> 17:53Presumably that would be
17:53 --> 17:56suspicious for a metastasis.
17:56 --> 17:58So what's the next step?
17:58 --> 18:00Do these patients routinely get a
18:00 --> 18:03biopsy of their brain to determine
18:03 --> 18:05whether that is in fact a metastasis?
18:05 --> 18:07Or are they treated?
18:07 --> 18:10On spec or how does that work?
18:11 --> 18:14Yep, so I work closely with my
18:14 --> 18:16medical oncology colleagues.
18:16 --> 18:20And if a patient that they're treating for,
18:20 --> 18:24say, breast cancer, develops.
18:24 --> 18:26Increasing headaches and had never
18:26 --> 18:29had headaches before and dizziness
18:29 --> 18:31or other neurological symptoms.
18:31 --> 18:33Their medical oncologists can
18:33 --> 18:35order an MRI at that time to
18:35 --> 18:37evaluate for an issue and then,
18:37 --> 18:40if lesions are found,
18:40 --> 18:43they would refer the patient to
18:43 --> 18:45me for a consultation and it can
18:45 --> 18:47review the situation in the scan
18:47 --> 18:50and typically for brain metastasis.
18:50 --> 18:53We actually can avoid a biopsy.
18:53 --> 18:55Imaging can be consistent with
18:55 --> 18:55that diagnosis,
18:55 --> 18:58and patients can be treated with
18:58 --> 19:01some radiation therapy strategies
19:01 --> 19:05and that can control the metastasis
19:05 --> 19:07and the patient can kind of just
19:07 --> 19:09continue on with their treatment.
19:09 --> 19:11At that point,
19:11 --> 19:13there's radiation therapies are
19:13 --> 19:15performed by radiation oncologists
19:15 --> 19:17and in some cases,
19:17 --> 19:19neurosurgeons who used advanced
19:19 --> 19:20radiation technologies.
19:20 --> 19:22Like the Gamma knife machine
19:23 --> 19:26and so so certainly radiation is 1
19:26 --> 19:29modality to treat brain metastases.
19:29 --> 19:32Oftentimes when we think about
19:32 --> 19:34metastases in general for cancers,
19:34 --> 19:38we think about more systemic kind of
19:38 --> 19:41therapies like chemotherapy or immunotherapy,
19:41 --> 19:43or even other targeted therapies.
19:43 --> 19:45So, for example, in breast cancer,
19:45 --> 19:48we might think about endocrine therapy,
19:48 --> 19:51but in terms of managing.
19:51 --> 19:53Brain metastases sometimes these
19:53 --> 19:56systemic therapies are not as effective
19:56 --> 19:59because of the blood brain barrier.
19:59 --> 20:01Can you talk a little bit more about
20:01 --> 20:02that and potentially strategies and
20:02 --> 20:05newer agents that might be able to
20:05 --> 20:07cross that bloodbane barrier better?
20:08 --> 20:11Right, the blood brain barrier is a
20:11 --> 20:13mechanism that developed to prevent
20:13 --> 20:16toxic molecules from crossing from
20:16 --> 20:18the bloodstream into the brain.
20:18 --> 20:20And so it was good for
20:20 --> 20:22evolution and brain health.
20:22 --> 20:24But it makes it challenging
20:24 --> 20:26to treat brain metastasis.
20:26 --> 20:28Fortunately, over the last decade,
20:28 --> 20:30there's really been tremendous
20:30 --> 20:33progress in the development of new
20:33 --> 20:35drugs to treat systemic cancers,
20:35 --> 20:37and some of these drugs can
20:37 --> 20:39cross the blood brain barrier.
20:39 --> 20:41Both molecular drugs,
20:41 --> 20:43particularly for some subtypes
20:43 --> 20:46of lung cancer and immunotherapy,
20:46 --> 20:49also can be highly effective for
20:49 --> 20:51some patients affected by brain
20:51 --> 20:54metastasis with cancer types
20:54 --> 20:57like lung cancer on Melanoma.
20:57 --> 20:59So being in in the field and in
20:59 --> 21:00practice it's really been exciting
21:00 --> 21:02for me to see these developments.
21:02 --> 21:06And now we have some medical options to
21:06 --> 21:08treat patients with brain metastasis.
21:08 --> 21:11Whereas about 10 years ago the options
21:11 --> 21:14really were just radiation or a surgery.
21:15 --> 21:19And so when a patient is
21:19 --> 21:21diagnosed with brain metastases,
21:21 --> 21:22what's their prognosis?
21:22 --> 21:25Because I can imagine that many patients
21:25 --> 21:28may be thinking to themselves, you know,
21:28 --> 21:31is it worth it to have more treatment
21:31 --> 21:34to have potentially chemotherapy or
21:34 --> 21:37immunotherapy and radiation therapy if
21:37 --> 21:40the prognosis is going to be dismal?
21:40 --> 21:42Can you talk a little bit about
21:42 --> 21:44what the implications of a brain
21:44 --> 21:46metastases are in terms of?
21:46 --> 21:47Diagnosis and has that
21:47 --> 21:48changed in recent years?
21:49 --> 21:52Well, I believe it has definitely
21:52 --> 21:54changed and it's improved.
21:54 --> 21:56Pretty significantly for
21:56 --> 21:57some patients, really,
21:57 --> 22:00it depends on the cancer type and then.
22:00 --> 22:02Really cancer subtype.
22:02 --> 22:05Is there potentially effective therapy
22:05 --> 22:08for this cancer subtype and what's the?
22:08 --> 22:10The amount of brain metastasis,
22:10 --> 22:11or the burden of brain metastasis,
22:11 --> 22:15is there only one lesion or a few lesions,
22:15 --> 22:18or is there a numerous lesions,
22:18 --> 22:22and so if a patient has a.
22:23 --> 22:25Type of lung cancer that can be
22:25 --> 22:26responsive to certain drugs.
22:26 --> 22:28What's called Osimertinib for
22:28 --> 22:30a subtype of of lung cancer.
22:30 --> 22:32This has activity against brain
22:32 --> 22:35metastasis and patients who may be able
22:35 --> 22:38to actually continue living for years with,
22:38 --> 22:39you know with this.
22:39 --> 22:41With this treatment for them.
22:41 --> 22:42Whereas in the past,
22:42 --> 22:45when these drugs haven't been developed yet,
22:45 --> 22:47the outlook was considerably
22:47 --> 22:49worse for these patients.
22:50 --> 22:52And are there exciting clinical trials
22:52 --> 22:56ongoing now that are looking at novel
22:56 --> 22:58treatments for brain metastases?
22:58 --> 22:59What's on the horizon?
23:00 --> 23:03It has been exciting to see a lot of
23:03 --> 23:05new drugs coming into development
23:05 --> 23:08and a renewed or really just a
23:08 --> 23:12new focus on brain metastasis and
23:12 --> 23:16CNS disease by investigators and.
23:16 --> 23:18Companies trying to develop
23:18 --> 23:19these novel treatments.
23:19 --> 23:20Think in the past.
23:20 --> 23:22Brain tumors were felt to be
23:22 --> 23:25difficult to treat and in a
23:25 --> 23:27difficult area to research there.
23:27 --> 23:29There wasn't as as much interest in treating,
23:29 --> 23:30but that's really changed
23:30 --> 23:32over the last several years,
23:32 --> 23:36and there's a number of of drugs in
23:36 --> 23:38development for all various types of cancers,
23:38 --> 23:41including primary brain tumors and gliomas.
23:41 --> 23:43Looking at ways to try to fight,
23:43 --> 23:45fight these cancers and to improve
23:45 --> 23:46the survival time and quality
23:46 --> 23:48of life for the patients
23:49 --> 23:50you know. Speaking of quality of life,
23:50 --> 23:52that's another question that I had.
23:52 --> 23:54Whether you have a primary brain
23:54 --> 23:56tumor or a secondary brain tumor,
23:56 --> 23:59one can imagine that the toxicity
23:59 --> 24:02of the regimens that you're given,
24:02 --> 24:04whether it's radiation therapy or
24:04 --> 24:06chemotherapy, can have side effects.
24:06 --> 24:09Whether it's you know swelling in the
24:09 --> 24:11brain that can cause other issues.
24:11 --> 24:14Whether it's fatigue, other things,
24:14 --> 24:17can you talk a little bit about the side
24:17 --> 24:19effects of treatment and some of the
24:19 --> 24:22ways that you and a multidisciplinary
24:22 --> 24:25team kind of help patients through
24:25 --> 24:27treatment of brain cancers?
24:27 --> 24:30For treatment of my patients,
24:30 --> 24:32I'm always considering a person's
24:32 --> 24:34quality of life and the impacts
24:34 --> 24:36that treatments would have on them.
24:36 --> 24:40And it sometimes can be a balancing act over.
24:40 --> 24:42What may be an effective treatment
24:42 --> 24:44to lengthen a person's life?
24:44 --> 24:45But on the flip side,
24:45 --> 24:46what kind of adverse side
24:46 --> 24:47effects could this cause?
24:47 --> 24:50And this is really leads to treatment
24:50 --> 24:52needing to be individualized for
24:52 --> 24:54every single patient, then,
24:54 --> 24:57particularly with primary brain tumors.
24:57 --> 25:00Really look at an individual patient.
25:00 --> 25:03And try to discuss with them what I
25:03 --> 25:06think would be really the optimal
25:06 --> 25:08treatment to achieve to achieve what
25:08 --> 25:11their outcomes are and and folks even
25:11 --> 25:13can have different perspectives on,
25:13 --> 25:15you know they're what they perceive to be
25:15 --> 25:17their quality of life and versus survival,
25:17 --> 25:18survival time.
25:18 --> 25:19And again,
25:19 --> 25:22it's an individual conversation and
25:22 --> 25:25with the team I work closely with a
25:25 --> 25:27colleagues in in different disciplines
25:27 --> 25:30and and everyone is instrumental in
25:30 --> 25:33the optimal management of brain tumor.
25:33 --> 25:35The other specialists include neurosurgeons,
25:35 --> 25:37radiation oncologists,
25:37 --> 25:40pathologists and radiologists,
25:40 --> 25:42and.
25:42 --> 25:44We have frequent meetings to
25:44 --> 25:46review patient cases and come up
25:46 --> 25:48with an optimal treatment approach
25:48 --> 25:51for a patient based on all of
25:51 --> 25:52our collective expertise.
25:53 --> 25:56You know one of the things that
25:56 --> 25:58comes up in this show routinely time
25:58 --> 26:01after time is this concept that you
26:01 --> 26:03mentioned of really personalizing
26:03 --> 26:05care to an individual patient,
26:05 --> 26:08and a lot of that seems to be really
26:08 --> 26:11driven by this explosion in genomics
26:11 --> 26:14and understanding genetic mutations
26:14 --> 26:16that can cause various cancers.
26:16 --> 26:19When we think about primary brain
26:19 --> 26:22cancers and even secondary brain
26:22 --> 26:24cancers tell us a little bit.
26:24 --> 26:26About how genomics or mutational
26:26 --> 26:28analysis of these tumors helps
26:29 --> 26:30to individualize therapy.
26:30 --> 26:32Is that something that's commonly done?
26:33 --> 26:35It is commonly done.
26:35 --> 26:37We consider that essentially
26:37 --> 26:40standard of Care now and.
26:40 --> 26:43There are different subtypes of Glioblastoma
26:43 --> 26:471 main differentiation being the status
26:47 --> 26:50of an enzyme called the N MGMT enzyme.
26:50 --> 26:53And now we've been able to develop
26:53 --> 26:55these various subgroups of patients.
26:55 --> 26:57And are trying to develop.
26:57 --> 27:01New treatment strategies. Unfortunately,
27:01 --> 27:03there this is all still in development.
27:03 --> 27:06There really has been no breakthrough yet for
27:06 --> 27:08various subtypes of primary brain tumors.
27:08 --> 27:11Uh, but with other cancers
27:11 --> 27:15like lung cancer in particular.
27:15 --> 27:17This strategy was looking, you know,
27:17 --> 27:19was evaluated evolved several years
27:19 --> 27:22ago and now various subtypes of
27:22 --> 27:24of lung cancers such as the ALK
27:24 --> 27:27mutated or alpha mutated lung cancer
27:27 --> 27:29has its own targeted therapies.
27:29 --> 27:31These can cross the blood brain
27:31 --> 27:33barrier and and be highly effective
27:33 --> 27:35at controlling all commutative lung
27:35 --> 27:37cancer that affects the brain.
27:37 --> 27:39So I'm hopeful that we'll get there
27:39 --> 27:41with glioblastoma treatment over the
27:41 --> 27:43next 10 years because I've seen these
27:43 --> 27:45breakthroughs occur in in other cancer.
27:45 --> 27:47IES, and that's been great to see.
27:47 --> 27:51You know the other question that a lot
27:51 --> 27:54of patients could ask is, you know,
27:54 --> 27:57was there anything that I did that could
27:57 --> 27:59cause this brain tumor or anything that
27:59 --> 28:02I could do to prevent brain tumors?
28:02 --> 28:05You know, we all hear about doing
28:05 --> 28:07crossword puzzles and keeping your brain
28:07 --> 28:09active to try to stay off dementia,
28:09 --> 28:12but is there anything that we can do to
28:12 --> 28:15kind of help mitigate against brain tumors?
28:15 --> 28:18Or the toxicity of brain tumor treatment.
28:19 --> 28:21I was just having a conversation with a
28:21 --> 28:23patient of mine yesterday about this and.
28:23 --> 28:26Was wondering like how how did I
28:26 --> 28:28get this and the truth is that.
28:28 --> 28:30For the vast, vast majority of people,
28:30 --> 28:32their brain tumors are just sporadic.
28:32 --> 28:35Doctor Nicholas Blondin is an assistant
28:35 --> 28:37professor of clinical neurology
28:37 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public radio
28:55 --> 28:57funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Brain Cancer Awareness Month 2022 with guest Dr. Nicholas Blondin May 15, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095