Glioblastoma: Confronting the beast >>

Battling this brain tumor takes a combination of powerful tools

By Quinn Eastman | Emory Medicine | July 31, 2014

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Cody Mahan, above, volunteered for a clinical trial that may improve surgical results by making his brain tumor more visible. Photo courtesy of Cody Mahan.

Cody Mahan and his family didn't think they would have to deal with cancer again so soon.

After graduating college, Mahan, 23, had earned a prestigious Department of Defense SMART scholarship and had just started working at Warner Robins Air Force Base. He was looking forward to a promising engineering career.

In December, he started to experience headaches and then pain in his neck. His family took him to a hospital close to where they lived in Tennessee, suspecting meningitis. Doctors discovered a tumor on the right side of his brain. "It was quite a shock," says Cody's mother, Lisa. "It was the furthest thing from our minds when we went to the ER."

They had thought cancer was behind them. As a teenager, Mahan had ALL (acute lymphoblastic leukemia) and had received full cranial radiation as part of his treatment. At the time, this was a standard prophylactic for patients with ALL. The radiation, his family suspects, may have led to the development of the brain tumor. In fact, radiation exposure is one of the only known risk factors for developing a brain tumor.

Mahan is fighting a different beast this time. Five-year survival rates for children with ALL are reaching 80%. Five-year survival rates for glioblastoma, the most common and most aggressive malignant brain tumor, are around 10 percent.

Glioblastomas are especially frustrating, often striking adults in the prime of their lives. They quickly spread within the confines of the skull, destroying normal brain cells. The tumors are heterogeneous, containing a mix of cell types, and are supported by a large system of blood vessels. And they can slip past barriers that oncologists have tried to put in their way, such as newer "targeted" therapies.

As daunting as this sounds, progress is taking place. For a time, it was not even clear from clinical trials if chemotherapy lengthened survival times in glioblastoma. But the drug temozolomide appeared to make a difference. Since the Food and Drug Administration (FDA) approved temozolomide in 2005, the five-year survival rate has tripled.

"We want to turn glioblastoma into a chronic disease, so that it's possible to keep it at bay for a decade, like with some other forms of cancer," says Jeffrey Olson, co-director of Winship Cancer Institute's brain tumor program. "So far, there have been incremental improvements in treatment, but no home runs."

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