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2019 Crystal Ball: Predictions & Hopes for Advances in Brain Tumor Research and Treatments in the New Year

What should the brain tumor community hope and watch for in the coming year? As we’ve done for the past three years, we’ve reached out to some of the leading experts in the brain tumor scientific and medical field to get their thoughts, forecasts, and hopes for brain tumor research and treatment development in 2019 (some responses have been edited slightly for length and clarity):

  • “What to watch for this year: Tocagen could show outcomes of their current large randomized trials for high-grade glioma patients, and, perhaps, there are other viral therapy trials that may show critical data in 2019.” – Dr. Hideho Okada, Professor of Neurological Surgery and Director, UCSF Brain Tumor Immunotherapy Program, University of California, San Francisco
  • “Over the past 5 years, we’ve observed innovations that define a group of glioblastoma (GBM) that respond to immune-based therapies. In 2019, building upon these observations, I predict that we will start to understand the molecular mechanisms that underpin responses in this group. This, in turn, will point us in the near future to methods that overcome the resistance to immunotherapies in the non-responding tumors.” – Dr. David Ashley, Director of the Preston Robert Tisch Brain Tumor Center at Duke University
  • “In 2019, as the political health care landscape changes and the [Affordable Care Act] access issues fluctuate, the needs of all our neuro-oncology patients — including their health insurance, access to care and therapy — and what that means to them, their caregivers, and their families will come to the forefront and gain significant attention.” – Dr. Isaac Yang, Associate Professor of Surgery, Neurosurgery, UCLA School of Medicine
  • “2019 will usher in a continued shift towards developing trials that enrich our understanding of how our therapeutics are working or not working in patients. With smart collaborations between advocacy groups, industry partners, and the research community, we can turn ‘negative’ trials into future successes in 2019.” – Dr. Edjah Nduom, neurosurgical oncologist in the Surgical Neurology Branch (SNB) of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health and head of the Brain Tumor Immunology Laboratory of the SNB
  • “I believe 2019 will bring us significant advances in our understanding of the immunobiology of malignant brain tumors and convincing evidence of the clinical effectiveness of immunotherapy in the treatment of some refractory brain tumors.” – Dr. Duane Mitchell, Phyllis Kottler Friedman Professor in the Department of Neurosurgery and the State of Florida Endowed Cancer Research Chair at the University of Florida College of Medicine, Co-Director of the Preston A. Wells Jr. Center for Brain Tumor Therapy and Director of the UF Brain Tumor Immunotherapy Program
  • “In 2019, advances in single-cell sequencing technologies and in our understanding of the unique biology of brain immunology will lead to better applications of current biological therapies, particularly immunological therapies. Additionally, 2019 will be the year of unique delivery systems, specifically endovascular strategies that promote localized disruption of the blood-brain-barrier.” – Dr. Frederick F. Lang, Professor & Chairman, Beau Biden Chair for Brain Cancer Research, Director, Brain Tumor Center, Department of Neurosurgery, University of Texas MD Anderson Cancer Center
  • “In 2019, I anticipate the emergence of more sophisticated tools evaluating drug distribution and targeted agents which deliver effective therapy to malignant brain tumors. The integration of understanding drug entry pharmacokinetics with molecular profiling of tumor tissue will ultimately aid in disease diagnosis and treatment options which pose less systemic side effects.” – Dr. Sadhana Jackson, Head of Developmental Therapeutics, Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
  • “We end 2018 and begin 2019 having firmly entrenched molecular/genetic diagnostics in brain tumor classification and diagnosis. In 2019 and beyond, we will begin the transition from using these markers merely for diagnosis to understanding their prognostic, but more importantly, their predictive relevance in a much more robust manner. This will set the stage for personalizing therapy for some patients, matching actionable targets to effective and brain-penetrant therapies. Combinatorial approaches, incorporating precision drugs and precise local therapies such as SRS will also become commonplace. Finally, major efforts in understanding the role and results of immune checkpoint inhibitors will become available.” – Dr. Minesh Mehta, Deputy Director And Chief Of Radiation Oncology, Miami Cancer Institute at Baptist Health South Florida
  • “I believe 2019 will demonstrate greater velocity in our efforts to improve outcomes for patients with brain tumors. Over the past few years, a better understanding of the molecular underpinnings of gliomas has drastically changed how we view these lesions – from a diagnosis derived from a sampling of cells under the microscope to distinct molecular pathway-driven-lesions that behave distinctly. This has guided and catalyzed research efforts and allowed targeted innovative clinical trials that we are just on the cusp of realizing hopeful benefits from. I am optimistic and confident that 2019 will start to show real evidence of the speed of progress ahead.” – Dr. Sean Sachdev, Department of Radiation Oncology, Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine
  • “In 2019, I am hopeful that we will make strides in leveraging our scientific understanding of GBM into designing impactful therapies. It will be important to develop, in parallel, therapies that target GBM in terms of both its heterogeneity and homogeneity, as it remains unclear whether personalized therapies or a “one size fits all” approach emphasizing a ubiquitous target will ultimately be more successful. Heterogeneity can be targeted through more personalized vaccine trials, immunotherapy protocols specifically designed for hypermutator patients, and continuing efforts to target molecular pathways such as EGFR that are altered in subsets of patients. Homogeneity can be addressed by developing inhibitors that target pathways which are somewhat ubiquitous, such as TERT promoter mutations, as well as continued development of therapies targeting proliferative cells through direct cell death and immunologic effects, such as oncolytic viruses — for which considerable recent strides have been made, including polio, adenovirus, and replicating retrovirus. All of this will need to occur with continued emphasis on quality of life – as we make strides in improving patient survival we must not lose sight of also prolonging the ability of patients to preserve their pre-treatment level of functioning for as long as possible.” – Dr. Manish Aghi, Professor in Residence of Neurological Surgery, Principal Investigator, Brain Tumor Center, Co-Director, Center for Minimally Invasive Skull Base Surgery, Faculty Member, UCSF Graduate Division in Biomedical Sciences, University of California, San Francisco

Advances in brain tumor research and treatments are accelerated by the generous support of the brain tumor community and philanthropic individuals, corporations, and organizations. To help speed the quest for a cure, consider a gift. Thank you for your ongoing commitment to finding cures!

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