 In tonight's Your Health, Dr. Graham Woodworth, he is the Professor of Neurosurgery at the University of Maryland School of Medicine and Director of the Brain, Tumor, Treatment and Research Center, University of Maryland, Greenabomb, Comprehensive Cancer Center, University of Maryland Medical Center. I think we got it all in there, doctor. Thank you so much for joining us. We really appreciate it. Thank you. It's great to be here with you. So, we're going to be talking about an aggressive form of brain cancer known as GBM. And Senator John McCain recently died from this. Can you talk to me a little bit more about glioblastoma and why, from what you and I have discussed, why it's so deadly? So glioblastoma is a devastating disease. Unfortunately, we've heard a lot about it in the news media recently with John McCain, Senator Tent Kedini and even Vice President Bo Biden, his son. So we've heard a lot about it and many family members that I talked to out there have shared stories with me of friends and loved ones that have suffered with this disease. And the problem with it is that we really don't have great treatments for it. We have surgery, we have radiation, we have chemotherapies, standard treatments, lots of things that have been exciting in years, recent years, but nothing has really changed the median survival for these patients, which really is in the range of 15 to 18 months from the diagnosis. What are the numbers like in terms of either people being diagnosed or how many may die from this disease every year? And it affects men more than women, from what I understand, right? Yes, slightly more. And about 15,000 new diagnoses a year, about the same number of patients die per year in the United States, many more worldwide. But in terms of cancer diagnoses, it's not a large number of patients, but it is the most common adult brain tumor that forms from within the brain itself. So how do you treat glioblastoma? And what is the prognosis? You mentioned a little bit about it before, but how do you go about treating it? Because there are several different forms of treatment, correct? Right. Most patients will have surgery as a first step, either for a biopsy or to remove as much of the tumor as safely possible. But unfortunately, surgery cannot cure this disease. Even if we remove everything that looks abnormal when we're there during surgery, we know that there are tumor cells that have invaded out into the functioning brain regions around the tumor. And we know that to be the case, because after surgery, even after the combined radiation and chemotherapies that these patients receive, the tumors currently or commonly recur in the two to three centimeter margin around the region where the first tumor was. So we know that there are tumor cells that invade out, and that's the real problem is that we can't remove the entire brain. We can't remove even half of the brain. So we need to find ways to treat those elements of the disease that can't come out with surgery and really aren't very responsive to the other treatments, the chemotherapy and the radiation that patients get after surgery. What are some of the symptoms that people typically experience? I know John McCain said he was tired and having double vision, but he just chalked it up to a busy schedule. But what are some of the symptoms that folks might experience if they have GBM? So for GBM, usually there are neurologic symptoms. Those could be anything from a headache to a seizure to something like weakness or things like that. So those would be the most common. It's uncommon with GBM to have it be found incidentally, meaning being screened for something and a scan of the brain is done and it's found. But that does happen in some rare cases. Let's go to the phones. We have a call from Robert from Fairfax County, Virginia. Robert, go ahead. My question is, are you familiar with tumor-treating fields? And could you comment on whether they were used for the treatment of John McCain? Okay. Thank you so much, Robert. You can't comment on McCain, but in general the topic, right? Yes. I don't know if Senator John McCain received tumor-treating fields, also called Novocure, which are really these alternating electric fields that are placed on the skin around the tumor, usually the scalp. And these are used for other tumors as well. But in the context of brain tumors, it is now an approved treatment. It's a newer treatment. In my opinion, we don't have conclusive data to really support it in all cases, but certainly we have patients that receive tumor treatment fields at the University of Maryland and believe it is useful in certain cases. But it's not a cure, that's for sure. In fact, there really is no cure for GBM. I want to move on over to this first-of-its-kind clinical trial in the U.S. that you'll be a part of, starting pretty soon as you mentioned to me, it involves blood-brain barrier. Can you tell me a little bit more about that? Sure. So this gets at the issue that I mentioned earlier about treating those areas of the brain that have invading tumor cells within them that really can't be removed with surgery because they're functioning components of the brain and by removing them, we leave the patients with significant neurological injury. So the issue is how can we get treatments into those areas of the brain where there are major barriers to the delivery of drugs and other therapeutics. So one of those main barriers is called the blood-brain barrier. And what that is, it's a very specific and unique interface between the blood vessel and the brain tissue that's unique to the brain. It protects the brain and really limits the number of drugs and things that can go into the brain as well as shuttling things out of the brain. So by having control of that interface, we really control in such a way that we can open the blood-brain barrier in these areas where the invasive tumor cells are, not the entire brain. And that's really the uniqueness of this technology that leverages the power of ultrasound to temporarily open the blood-brain barrier in these regions, giving us the possibility that we can deliver therapeutics to those areas and potentially spare the rest of the healthy brain. Sounds like it could be very promising and I guess time will tell. Let's go back to the phones right now. We have Jack on the line from Prince George's County. Jack, go ahead. Yes, if these tumors are left untreated, what is the difference in the quality of life and the length of time the patient lives? Thank you for your question. Yes, thank you. That's a complicated question because in many ways the quality of life of a patient with a tumor like this is dependent on where the tumor is. So if the same tumor is left untreated, say in the right frontal part of the brain, compared to the same tumor treated completely with surgery, radiation, and any other treatments that could be possible for that tumor, the difference would be approximately six months of survival for the untreated patient and approximately 18, 20, maybe more months for the treated patient. What are some other types of brain cancer, other common types of brain cancer, and are they more easily treated than GBM? So in terms of cancers in the brain, the most common type of cancer in the brain is actually a metastatic tumor to the brain. A tumor that forms in another part of the body that then grows in the brain, such as lung cancer. In terms of other tumors in and around the brain, the most common would be a meningioma, a tumor that forms from the skin of the brain called the meninges or the dura. And that's a very common tumor, more common in women than men. And in addition, another very common tumor around the brain is a pituitary tumor called the pituitary adenoma. President Jimmy Carter, he had metastatic melanoma, so it gravitated to his brain. But he also used immunotherapy. Is that something that you can use with GBM? So not currently, but there are a number of clinical trials ongoing testing different types of immunotherapy for GBM. We're very hopeful that an immunotherapy may work, because harnessing the body's own immune function to fight cancer has proved very successful for other cancers like melanoma and other forms of cancer, such as lung cancer. So if we can make that work, find a way to make that work for GBM, I think we may have a chance for a cure. I know you were talking about the average life span being about 15 months, but there are some people who seem to do a little bit, fair a little bit better. Can you talk to me a little bit about the length of time that they may have lived after being diagnosed with GBM, and receiving treatment, I'm assuming? Right, so one of the key differentiators that we found to differentiate GBM from other types of more aggressive brain cancer related to mutations in the genes. So recently the health organizations that characterize these types of tumors have differentiated these types of tumors, gliomas and GBMs, the most aggressive form, into different tumor types by these mutations. So if you have a certain mutation, the most common and well-known being the IDH, called stands for the isocitrate dehydrogenase enzyme, if you have a mutation in that enzyme, then the tumors behave less aggressively. So in those patients that may live 20 plus months, two years, three years out, it's common that they would have that mutation, and the biology of their tumor is less aggressive. What are your thoughts for the future for patients with GBM, optimistic that maybe this clinical trial will work, and perhaps even other treatments be offered up? Because right now there is no cure, but treatments are available. How do you see it for the future? I think that there are many promising technologies out there, and we're learning a lot about cancer. And I think by learning a lot about the disease, whether it's lung cancer, brain cancer, it gives us new ways to really think about it and treat it in ways that gets to the heart of the problem. Instead of reacting to a tumor that's already been found in the brain, maybe we can diagnose the disease earlier through a blood test or through a test of the spinal fluid that surrounds the brain. And then we may be able to get to the heart of the problem much earlier in the disease before it's become a major problem, and before symptoms have really become known to the patient. Dr. Graham Woodworth, it was a pleasure to speak with you, Professor of Neurosurgery at the University of Maryland School of Medicine. We appreciate you coming on by and sharing such information and such a timely topic when you consider about the recent passing of Senator John McCain. Also should mention, we mentioned Ted Kennedy and Beau Biden as well. But typically more senior in age than younger. Yes, most commonly in the 50s and 60s. Thank you so very much. We really appreciate your time tonight. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.