Arnold B. Etame, MD, PhD
Neurosurgeon, Scientist, Assistant Professor USF College of Medicine, Moffitt Cancer Center Department of Neuro-Oncology
Patients with brain cancers will require second-line therapies following failure with standard therapy. For these patients, the selection of second-line therapies is very important especially since the cancer is more resistant at that stage. Therefore, personalized cancer care strategies and clinical trials are paramount for patients whose brain cancers have progressed on standard therapy. For these patients, the Moffitt Neuro-Oncology Program is uniquely positioned to provide multiple treatment options from a large list of clinical trials in conjunction with innovative surgical approaches.
Surgery is an important component in treating patients with brain cancers that are refractory to therapy. Through surgery, we can characterize from a personalized-cancer-care perspective the molecular changes that have occurred between the original brain cancer and the now-resistant tumor. Usually resistant brain cancers produce proteins, which counteract the effects of chemotherapy and radiation. Such changes can then be employed in guiding therapy. As an example, a new signaling protein pathway for which there is a therapeutic solution can be uncovered. In that scenario, patients can be treated with agents that are unique to the biology of the cancer.
Surgery can also be critical for reducing tumor burden. Since the new cancer is mostly resistant, surgery reduces the amount of resistant disease that would require treatment thereby enhancing response to therapy. As an example, glioblastoma is one of the most lethal and resistant brain cancers for which there is a significant demonstrable benefit that correlates with how much tumor is removed in surgery. Therefore the paradigm has always been maximum-safe resection.
Another important goal of surgery is functional preservation so patients can easily transition to clinical trials after surgery. If neurological function is compromised, patients might not be able to withstand the rigors of clinical trials. Therefore, innovative surgical approaches for brain cancers are warranted. The overall goal is maximum-safe resection whereby the surgeon removes what is safely possible.
Thanks to technological advances in brain tumor surgeries as well as advances in personalized cancer care, Moffitt Cancer Center offers new hope for patients with resistant or difficult-to-treat brain cancers.