VIDEO: Challenges, opportunities in glioma treatment

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Gliomas differ from systemic cancers in a number of challenges. The most important is the blood-brain barrier. This excludes more than 90% of the universal cancer drugs that can be used to treat gliomas. And it's a major reason why progress has been so slow. But gliomas have some other important challenges, including tumor heterogeneity. And, recently, single-cell sequencing studies have shown that gliomas, especially glioblastomas, exist in at least four cellular states that can transition from one to the other.

And then there's also redundancy in signaling pathways. All of these make it much more difficult to treat gliomas than other systemic cancers. But there are also some emerging opportunities. There's been a lot of progress in using focused ultrasound and micro-bubbles to open up the blood-brain barrier for a number of hours. And this potentially allows large molecules to cross the blood-brain barrier. Recently there was evidence with antibodies against amyloid and Alzheimer's disease, showing improved efficacy with focused ultrasound. And the same technique can potentially be used to allow the delivery of large molecules, like antibody-drug conjugates, that have been very effective for other cancers to be used for gliomas.

There's also a lot of interest in developing drugs that have improved ability to cross the blood-brain barrier, primarily to treat brain metastases, but hopefully this will also extend to treatment of gliomas. And then, the past few years has also led to a new area of knowledge called cancer neuroscience where there's increased understanding that neurons can form synapsis with gliomas and contribute to glioma growth. And targeting that interaction opens up multiple new avenues of therapy. So there remain significant challenges, but there are also now emerging opportunities that hopefully will lead to better treatments.