What’s New in Adult Brain and Spinal Cord Tumor Research and Treatment?

Research is always going on in the area of brain and spinal cord tumors. Scientists and doctors are looking for causes and ways to prevent these tumors, better tests to help characterize these tumors, and better ways to trea them.

Lab tests of brain tumors

In recent years, researchers have found some changes in genes, chromosomes, and proteins inside brain tumor cells that can be used to help predict a person's outlook (prognsosi) or help guide treatment. Some examples of changes that can now be tested for include:  

  • IDH1 or IDH2 gene mutations
  • Chromosomal 1p19q co-deletions
  • MGMT promoter methylation

For more on the use of these tests, see Tests for Brain and Spinal Cord Tumors in Adults.

Researchers are looking for other changes in tumor cells that might help guide treatment.

Imaging and surgery techniques

Recent advances have made surgery for brain tumors much safer and more successful. Some of these newer techniques include:

  • Magnetic resonance spectroscopy (MRS) and magnetic resonance spectroscopic imaging (MRSI). In this approach, described in Tests for Brain and Spinal Cord Tumors in Adults), specially processed MRS information is used to make a map of important chemicals involved in tumor metabolism. MRSI can help surgeons direct their biopsies to the most abnormal areas in the tumor. It can also help doctors direct radiation to the right areas and evaluate the effects of chemotherapy or targeted therapy.
  • Diffusion tensor imaging (DTI), also known as tractography. This is a type of MRI test that can show the major pathways (tracts) of white matter in the brain. This information can be used by surgeons to help avoid these important parts of the brain when removing tumors.
  • Fluorescence-guided surgery. For this approach, the patient drinks a special fluorescent dye a few hours before surgery. The dye is taken up by some tumors, which then glow when the surgeon looks at it under special lighting from the operating microscope. This lets the surgeon better separate tumor from normal brain tissue. Researchers are now looking to improve on the dyes currently in use.
  • Newer surgical approaches for some types of tumors. For example, a newer approach to treat some tumors near the pituitary gland is to use a 3-D endoscope, a thin tube with a tiny video camera lens at the tip that allows the surgeon to see the small area around the tumor in 3 dimensions. The surgeon passes the endoscope through a small hole made in the back of the nose to operate through the nasal passages, limiting the potential damage to the brain. A similar technique can be used for some tumors in the ventricles, where an endoscope is inserted through a small opening in the skull near the hairline. The use of this technique is limited by the tumor’s size, shape, and position.

Radiation therapy

Some newer types of external radiation therapy let doctors deliver radiation more precisely to the tumor, which helps spare normal brain tissue. Techniques such as 3-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and proton beam therapy are described in Radiation Therapy for Adult Brain and Spinal Cord Tumors.

Newer methods of treatment planning are also being studied. For example, image-guided radiation therapy (IGRT) uses a CT scan done just before each treatment to better guide the radiation to its target.

Chemotherapy

Along with developing and testing new chemotherapy drugs, many researchers are testing new ways to get chemotherapy to the brain tumor.

Many chemotherapy drugs are limited in their effectiveness because the tightly controlled openings in the brain capillaries, sometimes referred to as the blood-brain barrier, prevents the drugs from getting from the bloodstream to the brain. Researchers are now trying to modify some of these drugs by putting them in tiny droplets of fat (liposomes) or attaching them to molecules that normally cross the blood-brain barrier, to help them work better. This is an area of active research and clinical trials.

Other new treatment strategies

Researchers are also testing some newer approaches to treatment that may help doctors target tumors more precisely. This could lead to treatments that work better and cause fewer side effects. Several of these treatments are still being studied.

Tumor vaccines

Several vaccines are being tested against brain tumor cells. Unlike vaccines against infections, these vaccines are meant to help treat the disease instead of prevent it. The goal of the vaccines is to stimulate the body’s immune system to attack the brain tumor.

Early study results of vaccines to help treat glioblastoma have shown promise, but more research is needed to determine how well they work. Researchers are also looking at combining vaccines with other treatments that could boost the immune response against tumor cells. At this time, brain tumor vaccines are available only through clinical trials.

Angiogenesis inhibitors

Tumors need to create new blood vessels (a process called angiogenesis) to keep their cells nourished. New drugs that attack these blood vessels are used to help treat some cancers. One of these drugs, bevacizumab (Avastin, Mvasi), has been approved by the FDA to treat recurrent glioblastomas because it has been shown to slow the growth of some tumors.

Other drugs that impair blood vessel growth, such as sorafenib (Nexavar) and trebananib, are being studied and are available through clinical trials.

Growth factor inhibitors

Tumor cells are often very sensitive to proteins called growth factors, which help them grow and divide. Newer drugs target some of these growth factors, which may slow the growth of tumor cells or even cause them to die. Several of these targeted drugs are already used for other types of cancer, and some are being studied to see if they will work for brain tumors as well.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chang SM, Mehta MP, Vogelbaum MA, Taylor MD, Ahluwalia MS. Chapter 97: Neoplasms of the central nervous system. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

Dorsey JF, Hollander AB, Alonso-Basanta M, et al. Chapter 66: Cancer of the central nervous system. In: Abeloff MD, Armitage JO, Niederhuber JE. Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Central Nervous System Cancers. V.1.2017. Accessed at www.nccn.org/professionals/physician_gls/pdf/cns.pdf on September 14, 2017.

Last Medical Review: March 5, 2014 Last Revised: January 21, 2016

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