VIDEO: High-grade brain tumors may require radiation, chemotherapy, clinical trials

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 Now, patients are really divided since 2021, so the WHO classification and brain tumor has really changed how we talk about mostly primary brain tumor -- that's mostly what I do. But 2021 really we divided or made really, really clear that IDH mutated patients versus IDH wild-types. So, there was now, in the past, patients that had been diagnosed with glioblastoma that have been now found that they have an IDH mutation and so they're not called glioblastoma anymore. So, we know that if you have an IDH mutation, your prognosis will be better, your ability to respond to treatment will be better. So how the treatment changed depending on grade is really, if we look at the IDH mutated patient, right? So, there is grade 2, 3 and 4 and now for grade 2 patients, really the treatment is, with the FDA approval of vorasidenib (Servier), now the treatment is really surgery, observation. If they had a great surgery and they're doing well and then initiation of vorasidenib (Servier) or Voranigo.

When the patient, we do know, that in IDH mutated patient that their tumor is dividing more, so a higher mutational index. So, grade 3 or grade 4 patients that we still need to think in those patients about radiation therapy. We do know that unfortunately drugs that like, Voranigo that are IDH inhibitors alone are not enough in the grade 3 or 4 patients. So, we still need to talk about surgery, radiation, chemotherapy, but we are looking at a combination of where we will be able to combine IDH inhibitors like Voranigo, and others that are coming, combine it with what is the standard of care with the radiation and the Tamada chemotherapy or the Lomustine chemotherapy.

Of course, now IDH wild type patients now are called glioblastoma, and if we think about the glioblastoma in the adults, so glioblastoma, and in the glioblastoma, we know, right? Those are the patients where most of our research is going because the tumor, this tumor is extremely aggressive and so the patients, all of our patients need maximal safe surgery, the radiation therapy three to six weeks. Six weeks in most of the patients, three weeks in the patients that are older or are more frail. In combination with Tamada, Temozolomide, and then after that with additional therapy. And then in this patient, so they really need the surgery, the radiation, the chemotherapy, when we talk about glioblastoma and then talk also a lot about clinical trial. This is really, we know that really for glioblastoma, the only approved treatment, or the, you know what we call the standard of care is the surgery, radiation with Temozolomide, the NovoTTF, the Optune device, at the time of recurrence, Avastin. But really looking after that, what is the next best thing, and really thinking about our clinical trial in those patient or the patient where we talk a lot and we're looking extensively into immunotherapy. How can we develop the right vaccines for those patients? There is interesting data we publish on then the Dendritic cell vaccine, CAR-T therapy, viruses, oncolytic viruses, so different agent and how to administer it. To go back and answer, so lower grade, probably surgery, IDH inhibitor, things like Voranigo. As the grade increase, that's when we need to add the radiation and the chemotherapy and the clinical trials.