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Senator McCain diagnosed with glioblastoma – What are the treatment options available?

Almost 10 years ago, U.S. Senator Ted Kennedy was diagnosed with a glioblastoma, the same primary malignant brain tumor that Senator John McCain was diagnosed with this week. We asked Tufts Medical Center neuro-oncologist, Suriya Jeyapalan, MD, MPH about this type of cancer and the treatment options or clinical trials Senator McCain might consider. 

What is glioblastoma? 

Glioblastoma is a primary malignant brain tumor, which means it’s a cancerous tumor that develops in the brain. It’s very rare – there are about 22,000 cases in the U.S. each year and it comprises only about 1-2% of all cancer in the U.S. 

What are the typical treatment options? 

It sounds like Senator McCain’s care team has already taken the first step, which is surgery. A neurosurgeon will perform a procedure to remove as much of the tumor as possible. That is typically followed by a combination of radiation and a chemotherapy drug called temozolomide, followed by monthly treatment with temozolomide for at least six months.  

Are there any new treatment options or clinical trials that might be considered? 

In 2015, the same principal investigator that found that temozolomide is effective in treating newly diagnosed glioblastoma, led a trial of combining temozolomide with a device called Optune™.  Optune™, created by a company called Novocure, is placed over the patient’s scalp and converts electricity into electromagnetic energy. These electromagnetic fields or tumor treating fields (TTFs), pass through the skull and brain tissue, targeting rapidly reproducing tumor cells and disrupting cell division of cancerous cells without damaging the brain’s healthy neurons. 

Recently, the FDA completed granted approval for TTFs in newly diagnosed glioblastoma patients. This is the third-ever positive randomized phase III trial for the treatment of newly diagnosed glioblastomas.

Tufts Medical Center was one of two locations in Boston and 83 hospitals nationwide to participate in the trial and treat patients using this device and were a top-ten accruer to the trial, worldwide. The results in sites across the world showed that the combination of temozolomide and TTFs, increased the 2 year survival rates to 42.5%.  In 2004, prior to the approval of the device and temozolomide, 2 year survival rates for glioblastoma were less than 5%.

TTFs in combination with temozolomide are definitely something that Senator McCain and his family should consider. In the patients we’ve treated in the Neuro-Oncology Program at Tufts MC, we have not seen cognitive issues when using this combination therapy and have seen a significant improvement of long-term survival rates.