July 31: Brain tumors have a devastating impact on those they affect, so it is understandable that the bulk of research efforts have historically been concentrated on higher grade, more advanced tumors, where patient outcomes are incredibly poor. Indeed, the Focused Ultrasound Foundation has funded a number of global clinical trials involving high-grade brain tumors, and the UK Foundation will be funding an early clinical trial using sonodynamic therapy to treat glioblastoma (an aggressive, high-grade brain tumor) in the near future.
Important though this work is, it does mean that lower grade brain tumors can be overlooked when it comes to research; consequently, there are even fewer clinical trials available for these patients.
Low-grade gliomas , classified as grade 2, are cancerous brain tumors that grow slowly at first but invariably progress to become high-grade, fast growing tumors over time. The reasons for this are not understood, making it impossible to predict a timescale or give an indication of risk for individual patients. This poses a considerable challenge to those living with LGGs, which patients often describe as feeling like “living with a ticking time bomb.”
LGGs usually affect young people in the prime of their life, often at the start of their careers or with very young families of their own, and there is no cure. Research into all brain tumors remains critically underfunded, and this is even more pronounced for LGGs. Like higher grade tumors, LGGs are particularly challenging to treat, as it is difficult to get medicines to cross the blood-brain barrier, a protective layer of tightly packed cells that make up the brain. Limited understanding of which treatments are effective for different low-grade brain tumor subtypes also represents a major barrier to improving patient outcomes.
Sophie Morse, PhD, an assistant professor in the Department of Bioengineering at Imperial College London, hopes to open the door to new treatment options with research supported by the Astro Brain Tumour Fund. Dr. Morse and her research group, which includes a student in the Focused Ultrasound Foundation’s Global Internship Program, is investigating a range of drugs in combination with low-intensity focused ultrasound in different subtypes of LGG in a preclinical model. The focused ultrasound is being used to temporarily open the BBB, giving the medicines better access to the tumor. Should these early investigations prove successful, there is the potential to leverage the lessons learnt from clinical research in high-grade tumors to rapidly develop similar trials for LGG patients. An exciting prospect, as Dr. Morse outlines:
“At the moment, we are at the early stages, concentrating on two specific subtypes, but our ambition – if we have the funding – is to test five different drugs and four different subtypes of LGG – giving us a strong sense of what might work best in different patients. Combining these findings with the work that is already being done using focused ultrasound to treat patients with higher-grade tumors, we hope to discover new treatment options for the successful management of LGGs. This could ultimately reduce worry for patients with LGG in the short term and the overall prevalence of high-grade tumors in the longer term.”
Mary Burton and Dawn Emerton, trustees of the Astro Brain Tumour Fund, share why the research is urgently needed:
“This research is vital because LGG brain tumor patients have very few effective treatment options. Radiotherapy to the brain can cause long-term cognitive effects, and chemotherapy is particularly grueling. The current treatments do not offer a cure. Alternative treatment options are urgently needed to help these predominantly young people live their lives as fully as possible.”