Prof. Paul de Souza, University of Western Sydney, Department of Medical Oncology, Liverpool Hospitals presents at the Brain Tumour Patient Forum, hosted by the Cure Brain Cancer Foundation.
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Brain tumour patient forum Paul de Souza Tests related to management
1. Tests related to management
Prof. Paul de Souza
Hosted by Cure Brain Cancer Foundation
2. Investigations during management
for Brain Cancer
Prof. Paul de Souza
University of Western Sydney
Department of Medical Oncology
Liverpool Hospitals
April 2014
3. Management principles
Primary brain cancer:
-Surgery / radiation / chemotherapy
Tests related to each treatment:
-Post-operative scans
-Blood tests
-Tests related to complications
-Imaging during follow-up: essentially CT
scan or MRI scans
4. Management principles
Secondary cancers to the brain:
-Surgery if possible
-Radiation (alone or after surgery)
-Possibly other treatments (eg.
chemotherapy)
Tests related to each treatment:
-Postoperative scans
-Blood tests
-Imaging during follow-up: essentially CT
scans, MRI scans, but also for primary
disease and other metastatic disease
5. clinicaloptions.com/oncology
Evolutions in VEGF-Targeted Therapy for GBM
Incidence Distribution of All Gliomas by
Histology Subtype
54
6.8
6.6
5.8
5.2
11
10.6 Glioblastoma
Anaplastic astrocytomas
Oligodendrogliomas
Ependymomas
Pilocytic astrocytomas
All other gliomas
All other astrocytomas
Central Brain Tumor Registry of the United States. Available at: http://www.cbtrus.org/reports/2009-
NPCR-04-05/CBTRUS-NPCR2004-2005-Report-.pdf. Accessed December 16, 2009.
13. clinicaloptions.com/oncology
2010 Annual Meeting of the Society for Neuro-Oncology
Case 1: Tumor Recurrence
Single-agent bevacizumab initiated March 27, 2008
MRI: August 28, 2008MRI: April 17, 2008
14. clinicaloptions.com/oncology
2010 Annual Meeting of the Society for Neuro-Oncology
Bevacizumab: Anti-VEGF Antibody
1. Vredenburgh JJ, et al. J Clin Oncol. 2007;25:4722-4729.
2. National Comprehensive Cancer Network guideline: CNS cancers (V.1.2008)
Recurrent GBM
at baseline[1]
After 4 cycles
bev/irinotecan[1]
Recommended second-line therapy in GBM[2]
The incidence of glioma by histologic subtype is as follows: glioblastoma, 54%; anaplastic astrocytoma, 6.8%; oligodendroglioma, 6.6%; ependymomas, 5.8%; pilocytic astrocytomas, 5.2%; all other gliomas, 11%; all other astrocytomas, 10.6%. Therefore, the majority of gliomas are glioblastomas.
MRI, magnetic resonance imaging.
As shown by the brain scans on this slide, single-agent bevacizumab was started in March 2008 and the tumor had decreased in size from the initial scan in April 2008 to the second scan in August 2008.
This slide shows an example of a patient with peritumoral edema who initiated bevacizumab therapy. In June 2009, the patient was receiving dexamethasone 8 mg twice daily, and by August 2009, the dose had been decreased to 2 mg once daily with concurrent bevacizumab every 2 weeks. Decreases in the size of the tumor as well as in the peritumoral edema were observed.