Immunotherapeutic advancements for the treatment of glioblastoma
Leonel Ampie and Christopher Dardis*
St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
*Correspondence:Dr. Christopher Dardis,Barrow Neurological Institute,Department?,
Address
christopherdardis@gmail.com
Abstract
Cancer patients (e.g. glioblastoma) are typically immunosuppressed. This appears to be a survival strategy of the more aggressive tumors and is in excess of that which would be expected by external factors e.g. chemotherapy, malnutrition, steroid use. Immunotherapy seeks to counter this by improving the body’s immune response to a tumor. Currently, the principal mechanisms employed are: 1) to improve an aspect of the immune response (e.g. T-cell activation) and 2) to encourage the targeting of particular antigens. The latter is typically achieved by exposing the immune system to the antigen in question, in vivo, or in vitro followed by re-introduction of the primed cells to the body. The clinical relevance of this approach has already been demonstrated for solid tumors such as melanoma and prostate cancer. Tumors of the nervous system remain a particular challenge in that their location is relatively ‘immune privileged’. We present a summary of progress in this area.
1. Introduction
Glioblastoma multiforme (GBM) is the most common primary central nervous system (CNS) malignancy and is considered a grade IV glioma by the World Health Organization (WHO)
A SEGA is a non cancerous tumor that occurs in the brain (TS Alliance). Treatment of this type of tumor is difficult, but possible. Barnes Jewish Hospital located in St. Louis Missouri offers treatment for patients with otherwise inoperable brain tumors. The treatment is provided by new technology that include the ablation of the tumor. Dr. Eric Leuthardt performs this surgery with a system known as the NeuroBlate. This system has been FDA approved for neurosurgery (Barnes Jewish Hospital). By taking a part in a clinical trial using the NeuroBlate technology, many patients are given a normal life
Glioblastoma (pronounced like gleO blastoma) is an incurable brain cancer,Survival rate is usually measured in months.This became a word that was instantly defined, researched, dissected, feared, and tried to comprehend and understand by family,friends and acquaintances of Larry McKee (McKee)who was personally affected from this single word, it was quickly added to their vocabulary, because of the of the events that transpired on October 22, 2011 that forever changed lives “Glioblastomas are tumors that arise from the astrocytes- the star-shaped cells that make up the “glue-like,” or supportive tissue of the brain. These tumors are usually highly malignant (cancerous) because the cells reproduce quickly and they are supported by a large network of blood vessels.”(A.B.T A..) He was diagnosed with stage four.
The primary ones include these types. Gliomas, the most common brain tumor involving the brain tissue. There are different grades and even types of gliomas. But if the tumor grade is higher, it will probably grow faster. Medullblastomas are brain tumors that in young children. Without treatment it will spread rapidly into the spinal fluid and other parts of the brain. But almost or half of the brain tumors found are benign. These types of brain tumors are usually Meningiomas and Neuromas. Meningiomas begin in the tissue membranes. Neuromas are in the nerves mostly in people over
In a recent issue of Science Translational Medicine, researchers at Johns Hopkins University have described how to combine two forms of cancer treatment, chemotherapy and immunotherapy, to improve the outcome of glioblastoma, an aggressive form of brain cancer. In experiments on mice, the researchers showed that chemotherapy delivered locally to the brain rather than systemically can preserve the strength of the immune system and allow for the use of immunotherapy.
Tumors can be classified into three types: 1) benign 2) pre malignant 3) malignant tumor. Benign tumors are those which are incapable of abrupt expanding and affecting the other healthy brain tissues. Premalignant tumor is a pre cancerous stage, if not treated properly it may lead to cancers. It is often considered as a disease. Malignant tumor grows rapidly with time an ultimately leads to death of patient. Malignant is a medical term describing a sever growth of a disease. The most common primary brain Tumors are gliomas, wherein 70% are in the group of malignant gliomas, glioblastoma multiform (GBM).The GBM is one of the highest malignant human
Glioma is a tumor that is a type of brain cancer. Glioma tumors are made up by cells called glial cells. Glial cells normally provide nutrition, oxygen, and structural support to the brain. Three types of glial cells can produce tumors. Gliomas are named after the type of glial cell that is involved in the tumor. A tumor is formed when the glial cells grow into an abnormal mass of tissue. Gliomas are one of the most common types of brain tumors that occur in adults.
DIPG (Diffuse Intrinsic Pontine Glioma) is a disease which strikes at the heart of childhood. At the base of the brain, just above the spinal cord is the brainstem. The tumor affects the pons area of the brainstem, supplying the nervous system function unattainable. ‘“There’s not a single drug approved”’ (Mukhopadhyay). Due to the location of the tumor, it cannot be surgically removed. Unfortunately, the only option available is Radiation that is considered temporary, with no benefits. “Chemotherapy is frequently ineffective, since anti-cancer drugs cannot cross the blood-brain barrier and reach the tumor” (Zhiping 2). In the end, leaves the patient and parents hopeless for fighting this
Glioblastoma Multiforme is an extremely aggressive brain tumor that can drastically alter how the body moves, a person’s memory, vision, emotion, thought, etc (GBM Guide). Having something in your brain that has the potential to drastically
Glioblastoma(GB) is the most common primary malignant solid brain tumor in adults1. Known for its aggressive characteristics and poor prognosis, the median survival rates of GB patients remain less than 18 months2,3. Tumor relapse owing to chemotherapeutic resistance is almost universal and GB is no exception, thus reflecting in high mortality and morbidity rates4. The WHO 2016 classification of brain tumors identifies GB tumors based on histology, molecular and genetic characterization into defined transcription profiles such as classical, neural, pro-neural and mesenchymal types5. Additionally, the commonly occurring genetic aberrations of primary GB are amplifications/mutations of EGFR, PDGFRA, PTEN, and of secondary GB are IDH1, MDM2
Glioma is a solid primary tumour that starts in the brain and has a very high mortality rate. Brain tumours are most common in adults but can also affect children. There are two types of tumours one type is called the low-grade tumour and this is the slow growing tumours that are referred to as non-malignant. High-grade tumours are fast growing and are referred to as malignant tumours. However even though there are different grades they both have the potential to cause harm. The high grade which are cancerous are the most difficult to treat this is because of highly vascularized nature of the tumour. Treating high-grade gliomas requires specific alterations within the cells. Patients who suffer from a brain tumour will have many symptoms.
The cancer cells that develop in the nerve tissues may vary and require different forms of treatments depending on its location and stage. After the detection of Neuroblastoma, various methods of testing are performed to identify where the cells have caused dysfunction and where they have
Normally, the onconeural antigens are expressed only in immunologically privileged sites, such as brain and testis(, which may explain that the immune system identifies these antigens as foreign following expression by the systemic tumor.Tumors in patients with PNS are often heavily infiltrated with inflammatory cells (in contrast to histologic features of tumors in non-PNS patients).The immune hypothesis of PNS is further supported by the following facts: The target onconeural antigens are expressed both in the tumor and in the affected parts of the nervous system; examination of the CSF frequently shows moderate lymphocytic pleocytosis, intrathecal synthesis of IgG and CSF-specific oligoclonal bands; pathological examination of the nervous system shows loss of neurons in affected areas with inflammatory infiltration by CD4+ T cells and B cells in the perivacular spaces and by CD8+ T cells in the interstitial spaces; control of tumor growth by the immune response is suggested by well documented regression or even obliteration of the underlying tumor (usually SCLC) at the time when PNS developed(Horino et al. 2006); finally, SCLC patients with low titers of anti-Hu antibodies (no PNS) a have more limited disease distribution and better
Furthermore, The authors haven’t discussed the durability of the Td vaccine in the long time survivors. Only 3 of the 6 patients who received Td did not progress and were alive at the time of analysis. Based on this variation there is a possibility that Td failed to elicit the same immune response in all the patients which could be due to other factors involving tumor microenvironment and more genetic studies to determine whether the 12 patients differed in any genetic mutations should have been performed. There are 4 distinct subtypes of glioblastoma: Proneural, Neural, Classical and Mesenchymal. These subtypes differ by the type of genetic abnormalities they carried and by the patient’s clinical characteristics.
Common malignant brain cancers increase significantly according to statistical data collected by the National Cancer Institute. In 1984, the annual incidence rates of primary brain tumor and primary brain lymphoma also increased notably, the rate of lymphoma almost tripling,
Another major breakthrough that occurred in the early 1970’s was the discovery of the first promising chemotherapy for glioma. A glioma is a malignant tumor that begins in the glial cells which surround the nervous system. Gliomas can be found in the brain and spinal cord. Researchers studied a chemotherapy drug called carmustine (BCNU) and