Recent advances in CNS tumour management

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Published: 22 Oct 2018
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Prof Joan Seoane - Vall d'Hebron Institute of Oncology, Barcelona, Spain

Prof Joan Seoane speaks with ecancer at ESMO 2018 in Munich about data from the latest trials in CNS cancers.

He highlights the heterogeneity of CNS tumours and the prevalence of molecular rearrangements, before addressing research into leptomeningeal metastasis and their management.

He also considers new insights into the genetic characteristics of brain tumours which relapse, and how the tumour microenvironment may play a role.

The session was really a good session, it was very informative, a lot of good work, all of them related to the necessity of understanding the heterogeneity of cancer and specifically, in this case, on brain metastasis, both leptomeningeal metastasis and regular brain metastasis. It was very important to see how we have to deal with this type of lesions as an entity and how we have to really understand the molecular characteristics of these lesions in order to have better treatment delivering in precision medicine.

That was very interesting work, study, it was a clinical trial focussed in leptomeningeal metastasis looking for a specific treatment derived from cytarabine. It was a very interesting trial because, as I said, they were considering leptomeningeal metastasis as an entity by itself. They found very interesting results in terms of time to progression, there was a very clear effect on there; there was no major effect on overall survival, that was understood, and also it was interesting to see an impact on quality of life of the patients.

Quality of care has been one of the main issues that has come up in terms of managing this kind of scenario.

This type of lesion, brain metastases, that are so aggressive so it’s very important not to take into account just the pure overall survival or time to progression but also the quality of life of these patients.

Then on to the next presentation if you please.

The next presentation was also very, very interesting and it’s a presentation that I think we will hear more and more about it. It’s important to know our enemy before treating it. So that presentation, what they did is characterised the primary tumour in the brain, the brain metastasis primary tumour, and then relapsed, so in order to know how the treatment was affecting the characteristics of the lesion. That’s very important because we need to know what to treat and for that we need to have some access to the tumour. What they found is that there is no measurable effect in the number of mutations that were found in the relapse when compared to the primary brain metastasis but there were some differences in certain cases in the microenvironment, indicating that that could also impact on the way we are treating these patients.

The bottom line is that we need to know, we need to characterise these tumours to know how they change with time upon treatment in order to have the better treatment. This is something that we have to be able to go through this because it’s a very important challenge. These lesions are within the brain so in order to have access to these samples to characterise them we have to do biopsies through the skull so it’s a very, very invasive and risky procedure. So we need to find new ways of accessing these samples or characterising these samples, maybe by imaging or also through the CSF. We can obtain some information at the level of DNA through the circulating tumour DNA or even by the analysis of cytokines or immune cells that might be in the CSF, the cerebral spinal fluid.

So the session less about practice changing but gaining understanding?

Exactly. The bottom line, as always, is we need to really understand, really study these tumours in order to have better treatments and we have to really be able little by little to understand and look for new targets and look for druggable targets that will help us in a better treatment.

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