Insights From: Maciej Mrugala, MD, PhD, MPH, University of Washington Medical Center; Suriya Jeyapalan, MD, MPH, Tufts Medical Center; Daniela Bota, MD, UC Irvine Medical Center
Maciej Mrugala, MD, PhD, MPH: Glioblastoma is a primary brain tumor that originates, typically, in the brain structures. It is in that way different from other primary solid tumors, let’s say breast cancer or melanoma, that can potentially travel to the brain. This means that they would constitute a secondary brain tumor as opposed to glioblastoma, which is the primary. It is the most common malignant glioma, and it’s very invasive, very aggressive. Because of that, the prognosis associated with the diagnosis is relatively poor. There are usually two different types of glioblastoma, and we are now understanding more and more about this. Some of them originate from lower grade tumors, lower grade gliomas. Some of them originate de novo. They start as a high-grade glioma. And we can frequently tell which one is which based on the molecular testing that we typically attempt in each tumor sample. In my practice, I think I probably see maybe 60% to 70% of patients with primary glioblastoma and maybe 30% to 40% of patients with secondary glioblastoma.
The overall survival in glioblastoma, depending again heavily on the molecular status of the tumor, can be anywhere from 12 months to over 20 months. Again, it depends on the molecular status of the tumor and also the treatment provided to the patient.
Suriya Jeyapalan, MD, MPH: The typical patient with a glioblastoma in the United States is still white middle-aged men. However, it is seen in all age groups. Unfortunately, it is seen in children and it’s pretty devastating when it does occur in children. But, in adults, there is a second peak in the older age group above 70. People always ask me this—everybody is always very scared that it’s your cellphone that causes it, or something they’ve done to themselves. And what I can say is there has never been any correlation through the cellphone, alcohol, or tobacco. None of that has ever caused or has been shown to be correlated with GBMs, but radiation has been shown. And they know this from the 1950s. Back in Russia, they used to try to treat children with radiation for tinea capitis, which is just basically ringworm of the scalp, or a fungal infection of the scalp. And, of course, the fungus died after it was radiated. And then, those children immigrated to Israel as adults, and they were diagnosed with meningeal as an astrocytoma. So, that was something that came from the 1950s when we really didn’t know too much about radiation. But, nowadays, obviously, we don’t get radiation exposures like that any more, so it really is just random bad luck, unfortunately.
Daniela Bota, MD: The question is, how do the patients present with glioblastoma, and what kind of specific symptoms are associated with the newly diagnosed glioblastoma patients? Most of the times, it’s interesting. The glioblastoma patients do not present in a dramatic way. The way in which they present is with a constellation of 3 different symptoms. Most of the patients will actually present with headaches. A second category of patients will present with cognitive problems—memory, speech. And a third category of patients will present with seizures. That is why the majority of the patients will present to the office of their primary care doctor or their neurologist, and only a minority of the patients will present at emergency room visits.
Maciej Mrugala, MD, PhD, MPH: The incidence of glioblastoma is overall increasing. We are seeing more patients with this condition. Also, the age of the diagnosis appears to have shifted. It used to be a disease of patients in the 60-, 70-years-old category, now we are seeing more and more patients in the late 20s, 30s, and 40s. In a typical week, I might see 1 to 2 newly diagnosed patients. It sometimes comes in waves. In 1 week, we can potentially have up to 5 patients and then we can have another week when we don’t have a case. But, on average, it’s 1 to 2 cases per week in a large academic center in a large city, and my colleagues also see a similar number of patients. So, that would be the average number of cases we see.