This month, the ANA talks with Jerome Graber, MD, MPH, an Associate Professor at the University of Washington who specializes in neuro-oncology. Dr. Graber discusses treatment options that improve quality of life for patients, his work with applications of neuroimaging, and more.
What does the public need to understand about neuro-oncology that it often doesn’t?
So many families come to us devastated and feeling overwhelmed, often with outdated information and pessimistic impressions. I wish more people got accurate, updated information from their initial diagnosis to help guide their initial decisions and make the diagnosis less traumatic and stressful. I think this would help more families choose wisely the right treatment options for them (especially clinical trials), and not rush to apply an over simplified "one-size-fits-all" approach.
For me, part of my mission for patients everywhere is that I hope all neurologists are comfortable with brain tumor patients and with cancer patients. Cancer, unfortunately, is extremely common and neurologic complications of cancer some of the most common complications of cancer and its treatment.
We really need neurologists everywhere to be knowledgeable and comfortable with cancer patients. A lot of major cancer centers are now hiring general neurologists, not neuro-oncologists, because they need someone to take care of all their patients with memory problems, headaches, seizures, and neuropathies. Oncology has gotten so complicated, it really is difficult to keep up.
How are treatment options for neuro-oncology different today from 10 years ago?
There have been incremental but important improvements that have, in fact, improved outcomes. The improvements in imaging, surgical, and treatment approaches really have improved quality of life and we are seeing a small but very noticeable minority of patients living not only much longer, but better, after their initial diagnosis and treatment.
If you look at the clinical trials for glioblastoma that were reported in the last 10 years, the median overall survival for those does not look like progress. However, what really is different is that a subset of patients has a significant response to treatment: 20% to 30% of GBM patients do have good disease control for sometimes two to four years. And I think that's what gets lost in the data and the way it's discussed. That’s where the bar has really moved. In addition, the nice thing about these treatments is they’re extremely safe and well-tolerated. This is not your old-fashioned “chemo” that makes people horribly ill.
What promising research is poised to change the standard of treatment for neuro-oncology?
It's very hard to choose! So much has changed in oncology, with molecular knowledge of driving pathways, immunology (where immuno-oncology and neuro-immunology intersect is a fascinating field), and better understanding of different molecular tumor subtypes, as well as applying better management of neurologic symptoms likes headaches and epilepsy really improving quality of life.
A field that has changed by leaps and bounds, and I think people don’t appreciate, is neuroimaging in all of our fields. For many of us who are specialists, we only know about the answers in our field, but when you step back and look at how neuroimaging has changed and improved patient care in many different fields, it really is kind of incredible.
What work is your lab undertaking to move understanding or treatment for neuro-oncology forward?
Lately, I have been working on better applications of neuroimaging, and especially alternative advancing imaging modalities to improve diagnostic accuracy of tumor subtypes (like T2-FLAIR mismatch in IDH mutant astrocytomas), as well as unique manifestations after proton radiation. I also do work on CNS lymphoma (where novel agents can produce exciting disease remissions) and neuropalliative care.
How has the ANA supported your career and/or work in this area?
The ANA serves as a forum to efficiently hear about advances in other fields that give me ideas for my own research, as well as clinically-grounded updates from other specialties that improve my ability to provide the best possible neurologic care to my patients, which really can improve and extend their quality of life.