Advances in Brain and Spinal Cord Tumor Research

Diagnosis of Brain and Spinal Cord Tumors 

Many types of brain and spinal cord tumors look similar when the cells are examined under the microscope. Even with trained pathologists examining tissue samples, up to 10% of people with a brain or spinal cord tumor receive the wrong diagnosis at first. This can potentially affect outcomes, because tumors that look similar at the cellular level may require very different treatments.

NCI-funded researchers are studying ways to improve the diagnosis of brain and spinal cord tumors. For example:

• A type of blood test called a liquid biopsy was able to distinguish between several different types of brain tumors in adult patients. This test checks for chemical changes in tumor DNA that had been shed into the bloodstream. Researchers hope that such tests could not just improve the accuracy of diagnoses but someday be used to diagnose brain tumors without the need for invasive surgery to get biopsy samples. 
• A different liquid biopsy test was able to detect a specific genetic alteration in children with a rare type of brain tumor. Such tests could eventually help select patients for studies of new targeted therapies.
• Another study found that a blood test that detects genomic changes in DNA shed from a brain tumor called medulloblastoma could identify children who still had evidence of cancer after treatment. Such children are at high risk of relapse and may benefit from more aggressive therapy upfront.
• Scientists are also testing the use of artificial intelligence, or AI, for the analysis of images to speed the diagnosis of brain tumors during surgery. 

If you have received a diagnosis of a brain and spinal cord tumor and are seeking a second opinion, the NCI-CONNECT program offers free consultations, as well as advice for patients’ cancer care teams at home. The program also runs clinical studies and trials focused on the treatment of rare adult brain and spinal cord tumors and on improving quality of life, symptom control, and management of side effects.

New Treatments for Brain and Spinal Cord Tumors in Adults 

The mainstays of treatment for most types of brain and spinal cord tumors are surgery and radiation therapy. For some types of tumors in the CNS, chemotherapy is also used. 

Because these treatments can damage normal cells as well as tumor cells in the brain and spinal cord, they may come with serious side effects. These include memory and thinking problems, mood changes, and difficulty walking. In addition to their toxicity, these treatments are not always effective, especially for aggressive types of brain cancer, such as glioblastoma. This cancer, the most common type of brain tumor, usually comes back (recurs) rapidly after treatment.

Researchers are searching for ways to improve the treatment of brain and spinal cord tumors, including the following three strategies:

Targeted therapy for brain and spinal cord tumors

Personalized medicine uses information about a person’s own genes or proteins to prevent, diagnose, or treat disease. Over the last decade, scientists have discovered that tumors arising from the same type of cell can be driven by many different gene changes (also known as gene mutations). Such genetic studies hold the promise of more personalized treatments. 

• For example, recent studies have found that some brain tumors have mutations in a gene called IDH. For tumors with this kind of alteration, treatment with a type of drug called a PARP inhibitor may make them more sensitive to chemotherapy. A clinical trial is testing this strategy in people with a type of brain tumor called a glioma that has recurred after initial treatment. Other treatments for IDH-mutated tumors are targeting changes in cancer metabolism.
• Researchers are also beginning to use powerful computers to look through enormous databases of genetic mutations and combinations of genes, called gene fusions, found in brain tumors. Doing so may help them pinpoint which ones the cancer cells rely on to survive. These mutations and fusions could then potentially be targeted with new or existing drugs.
• Other studies are trying to target proteins found widely in CNS tumors. For example, NCI researchers are testing a drug that blocks dopamine receptors in recurrent brain and spine tumors. Dopamine receptors are found in many of these tumor types, including glioblastoma, lower grade gliomas, and medulloblastoma.

Scientists are also trying to understand other biological factors that influence brain tumor development and its response to treatment. For example, studies have found that women are less likely than men to be diagnosed with glioblastoma and their tumors tend to respond better to standard treatments. Such work may uncover further avenues for treatment personalization.

Personalizing treatment of brain and spinal cord tumors makes it challenging to test new drugs, because clinical trials will be limited to fewer patients with already rare cancers. Examples of NCI-led initiatives include the following:

• The NCI-led Brain Tumor Trials Collaborative (BTTC) and NCI-CONNECT clinical trial network are established at 33 cancer centers across the county to make it easier for people with rare brain and spinal cord tumors to participate in clinical trials closer to their homes.
• NCI researchers are leading efforts to reduce other barriers to clinical trial participation for people with brain or spinal cord tumors. These include allowing older adults or people who have previously been treated for other types of cancer to participate. Promoting the use of telehealth and collection of blood tests at local hospitals may also reduce the need for people to travel to participate in a research study.

Improving the response to radiation 

Radiation therapy is already personalized to some extent because the amount and shape of the tissue that gets treated is tailored to each tumor’s size and location. However, the dose (or amount) of radiation used is usually the same for everyone with a specific tumor type. 

• Researchers want to find ways to figure out whether a tumor’s response to radiation can be predicted before treatment. That would make it possible for people with tumors that are unlikely to shrink after standard doses of radiation to instead join clinical trials that are testing strategies like higher radiation doses. Scientists are studying whether machine learning, also called artificial intelligence or AI, can use data from MRI scans of brain tumors to predict radiation response.
• Scientists are also trying to develop substances called radiation sensitizers, which increase the damage radiation does to tumor cells but not normal cells. Dozens of small clinical trials across the country are studying radiation sensitizers in glioblastoma. For example, a trial led by NCI researchers is looking at whether the drug selinexor (Xpovio), when combined with chemotherapy and radiation, can improve survival.

Immunotherapy

Immunotherapy uses substances to stimulate or suppress the immune system to help the body fight cancer. In some blood cancers and solid tumors, immunotherapy drugs have provided huge gains in survival for some people. But to date, immunotherapy has not worked well for brain tumors. Issues may include

• The blood–brain barrier, which is a network of blood vessels and tissue that helps protect the brain. This barrier also prevents some drugs and types of immune cells from reaching tumors. 
• The widespread use of anti-inflammatory drugs called corticosteroids to manage the symptoms of brain tumors. For example,
  • A recent NCI-funded study found that corticosteroids may reduce the effectiveness of immunotherapy for brain cancer by suppressing the body’s immune response. 
  • Another study from NCI researchers found that steroids used to treat brain cancer may affect the development of T cells, which are key immune cells for fighting cancer. 

However, some people with CNS tumors given immunotherapy in clinical trials have had their tumors shrink or disappear. Researchers want to know if these responses could be predicted, both to spare people unnecessary treatment and to develop new strategies to make resistant CNS tumors respond to immunotherapies. 

• NCI researchers are running a clinical trial testing a combination of two immunotherapy drugs in people with newly diagnosed brain tumors. As part of the study, they’re testing whether there are changes in the types and level of activity of immune cells in the blood both before and during treatment. Measuring these changes might help predict who will benefit from immunotherapy and who won’t. 
• Another study led by NCI researchers is testing whether the immunotherapy drug nivolumab (Opdivo) can shrink or control the growth or spread of specific types of recurrent rare brain or spine tumors. The trial is also testing the changes that nivolumab induces in immune cells in the blood during treatment, and whether the drug can improve the symptoms of people with these tumors.
• Other studies are examining whether people whose brain tumors have certain mutations, such as those in the IDH gene, are more likely to have their tumors shrink from immunotherapy.

Survivorship and Quality of Life for People with Brain or Spinal Cord Tumors

Because both CNS tumors and their treatments can be debilitating, researchers are looking for new ways to improve quality of life for people with these tumors.

• This may include using people’s quality of life to measure the benefit of new drugs or treatment combinations. For example, in a recent NCI-led trial of a drug combination to treat a rare CNS tumor called ependymoma, most people’s tumors didn’t shrink. However, because they reported a reduction in symptoms from their tumor, the combination is now included in some professional recommendations for treatment of this cancer. 
• NCI scientists are looking at whether genomic factors can predict the likelihood that a patient will experience side effects from certain treatments. They’re also performing experiments in the lab to understand the biological processes linked with these side effects, information that could potentially influence treatment decisions.
• For people with many cancer types, simply monitoring symptoms has been found to improve not just quality of life but survival. An NCI study is tracking symptoms and the well-being of people with brain and spinal cord tumors over time. People in that study can also take part in research to improve sleep and reduce distress, anxiety, and depression, such as using virtual reality to reduce stress. 

Treatment of Brain and Spinal Cord Tumors in Children

Tumors of the brain and spinal cord in children are relatively rare. But about 4,000 children and adolescents nationwide receive a diagnosis of a brain or spinal cord tumor every year, making CNS tumors the second most common cancer type in this age group after leukemia.

Treatment has improved for young patients with these tumors over the last several decades. Although some CNS tumors can’t be cured, almost three-quarters of children and adolescents treated for a brain or spinal cord tumor will be alive 5 years after diagnosis. 

However, effective treatments can harm children’s developing nervous systems. Current research in childhood brain and spinal cord tumors focuses on understanding the underlying causes of these cancers, developing new treatments, and reducing the toxic effects of effective therapies. For example,

• One study found that some children with medulloblastoma, a type of brain cancer, can safely get less radiation therapy without reducing their long-term survival. The effectiveness of this approach depended on the genetic alterations found in children’s tumors. A follow-up study is looking more closely at reducing the intensity of treatment in children with medulloblastoma caused by changes in a gene called WNT. 
• Some children with a type of brain tumor called low-grade glioma have a certain change in a gene called BRAF in their cancer cells. Recent results from a clinical trial found that, for these children, a combination of two targeted drugs was safer and better than standard chemotherapy at shrinking these tumors and keeping them from growing again. These drugs, dabrafenib (Tafinlar) and trametinib (Mekinist), can be given orally as a liquid, making treatment easier for children as well.
• A targeted drug called selumetinib (Koselugo) is approved for treating nerve tumors in children with a rare condition called neurofibromatosis type 1 (NF1) . A small study found that it could also shrink a type of brain tumor called low-grade glioma in some children with NF1 whose tumors have certain BRAF changes. NCI researchers have launched a clinical trial of the drug in children with and without NF1 who have low-grade glioma with these BRAF changes.
• A rare type of brain tumor called diffuse midline glioma, which occurs more commonly in children than adults, currently has no cure. An NCI-funded clinical trial is testing CAR T cells, a type of immunotherapy, that target cells with a mutation found in some of these tumors. The treatment has been found to shrink tumors and reduce neurologic symptoms caused by the tumor in some children.
• Other studies are using information about mutations in children’s brain tumors to test new treatments in those who may benefit the most. One such study, the Pediatric MATCH study is testing new targeted therapies in children with solid tumors—including those in the brain or spinal cord—that have not responded to standard treatments. In the study, children are assigned to an experimental treatment based on the genetic changes found in their tumors rather than on their type of cancer or cancer site.

Additional clinical trials for children with CNS tumors are being performed by the NCI-sponsored Children’s Oncology Group and Pediatric Brain Tumor Consortium.

NCI-Supported Research Programs

Many NCI-funded researchers working at the National Institutes of Health (NIH) campus, as well as across the United States and throughout the world, are seeking ways to address tumors of the brain and spinal cord more effectively. Some research is basic, exploring questions such as the biological underpinnings of cancer. And some is more clinical, seeking to translate this basic information into improving patient outcomes. The programs listed below are a small sampling of NCI’s research efforts in brain and other CNS tumors.

• The NCI-CONNECT Rare Brain and Spine Tumor Network is part of the Rare Tumor Patient Engagement Network, an initiative supported by the Cancer Moonshot℠. The network aims to advance the understanding of rare adult CNS cancers by establishing and fostering patient–advocacy–provider partnerships and networks to improve approaches to care and treatment. Consultations are free of charge for people seeking a second opinion or expertise on a rare CNS tumor type.
• The Brain Tumor Trials Collaborative network includes over 30 institutions with expertise in neuro-oncology from across the United States. The network’s mission is to develop and carry out clinical trials in a collaborative environment to advance treatments for patients with brain and spine tumors. NCI serves as the lead institution, providing administrative support, a clinical database, and oversight for the network.
• NCI’s Brain Cancer Specialized Programs of Research Excellence (SPOREs) promote collaborative, interdisciplinary research. SPORE grants involve both basic and clinical/applied scientists working together. They support the efficient movement of basic scientific findings into clinical settings, as well as studies to determine the biological basis for observations made in individuals with cancer or in populations at risk for cancer.
• NCI's National Clinical Trials Network (NCTN) is a collection of organizations and clinicians that coordinate and support cancer clinical trials at more than 3,000 sites across the United States and Canada. NCTN has a variety of trials testing treatments for brain and other CNS tumors.
• NCI has also formed partnerships with the pharmaceutical industry, academic institutions, and individual investigators for the early clinical evaluation of innovative cancer therapies. The Experimental Therapeutics Clinical Trials Network (ETCTN) was created to evaluate these therapies using a coordinated, collaborative approach to early-phase clinical trials. The ETCTN is currently running early-stage trials in brain and other CNS tumors.
• NCI’s Division of Cancer Epidemiology and Genetics conducts studies on people with brain and other CNS tumors to learn about genetic and other risk factors for these diseases.

NCI’s Office of Cancer Survivorship, part of the Division of Cancer Control and Population Sciences, supports many research projects that study survivorship issues in people who have been treated for brain tumors.

Clinical Trials

NCI funds and oversees both early- and late-phase clinical trials to develop new treatments and improve patient care. Our clinical trials search form can be used to find trials to treat glioblastoma, glioma, medulloblastoma, and other types of brain and spinal cord tumors.

Brain and Spinal Cord Tumor Research Results

The following are some of our latest news articles on brain and spinal cord tumor research.

• Engaging People with Low-Grade Glioma in Cancer Research
• Targeted Drug Combo May Change Care for Rare Brain Tumor Craniopharyngioma
• Vorasidenib Treatment Shows Promise for Some Low-Grade Gliomas
• How Some Brain Tumors Hijack the Mind to Grow
• Vulnerability in Brain Tumors May Open Door to New Treatments
• For Some Kids with Brain Cancer, Targeted Therapy Is Better than Chemo

View the full list of brain cancer research results and study updates.