Improvements in Mind Tumor Remedy: A Podcast Exploration

“The most important factor that’s occurred up to now 5 to 10 years in mind tumor care has been the genomic revolution hitting our subject,” says Andrew Dhawan, MD, PhD, a doctor scientist with Cleveland Clinic’s Rose Ella Burkhardt Mind Tumor and Neuro-Oncology Heart. “What meaning is we’re significantly better capable of classify tumors in accordance with their underlying biology versus solely what they appear to be below the microscope. This expanded skill arises from strategies like entire exome sequencing and methylation arrays that permit us to actually decide up the precise subtype of the tumor so we are able to extra precisely deal with a affected person’s illness.”

Within the newest episode of Cleveland Clinic’s Neuro Pathways podcast, , Dr. Dhawan expands upon these genomic advances and different developments in mind tumor diagnostics and remedy, with an emphasis on the notoriously difficult-to-treat glioblastoma tumor kind. In a wide-ranging dialogue with podcast host and fellow neuro-oncologist Glen Stevens, DO, PhD, he touches on the next:

• An summary of glioblastoma and its remedy challenges
• Advances in molecular diagnostics by means of genomics and methylation
• Spinal fluid evaluation for tumor biomarkers
• Tumor resistance in neuro-oncology
• Wearable expertise for monitoring sufferers with mind tumors

Click on the podcast participant above to hearken to the 27-minute episode now or learn on for an edited excerpt of its transcript. Take a look at extra Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Glen Stevens, DO, PhD: You may have a selected curiosity in using technology-based purposes in glioblastoma care and affected person monitoring. Inform us a bit about your work on this space.

Andrew Dhawan, MD, PhD: One among our focuses is bringing wearable gadgets — issues like smartwatches and smartphones — to the clinic. These gadgets are widespread and cheap instruments we are able to use to get a superb window into how folks’s well being adjustments over time.

We’re particularly that within the context of sufferers with glioblastoma by monitoring what we name actigraphy measures in actual time. These are metrics like strolling pace, step depend and the whole lot that’s captured by these gadgets’ sensors, together with coronary heart charge, coronary heart charge variability, arm swing, and so forth. It seems that we are able to really predict issues and, hopefully, tumor development earlier than it seems on the MRI, with the purpose that we may assist folks resolve whether or not or not remedy must be switched earlier.

One instance of a complication we will be alerted to prematurely is a thromboembolic occasion similar to pulmonary embolism (PE). A major change in a affected person’s coronary heart charge or coronary heart charge variability, as detected by their wearable machine, could be a sign for PE danger. And that’s necessary as a result of glioblastoma is a extremely thrombogenic most cancers, with thromboembolism affecting about 30% of sufferers with glioblastoma. So it’s a significant complication we fear about. Fortuitously, not one of the sufferers in our examine have had a PE at this level, but when they had been to, we’d search for that kind of sign.

Dr. Stevens: There was an attention-grabbing examine quite a lot of years in the past that checked out train in sufferers with grade 3 or 4 astrocytomas. It confirmed that sufferers who had been capable of train 5 days per week, for half-hour at a time at a brisk tempo, lived twice as lengthy, on common. It is at all times arduous to rule out confounding results in research like that, nevertheless it raises some questions. Are you monitoring steps along with your sufferers or in some way encouraging them to ambulate extra?

Dr. Dhawan: We’re not but nudging sufferers to do any intervention. That’s a part of the subsequent part of the investigation. However we’re monitoring step counts. In reality, step depend has been in all probability our strongest sign to this point of whether or not the tumor is getting worse, as the quantity of strolling and motion is without doubt one of the first issues to go down when a tumor progresses.

Strolling steadiness has been the opposite sturdy sign we’ve noticed. When a big mind lesion like glioblastoma progresses, one of many issues that is most affected is the gait circuit. We will measure that basically nicely with actigraphy knowledge, particularly with massive parietal lesions. So we do see that sign as nicely.