Twelve questions to answer that will drive the brain tumor research field forward
“I think that this year is even more accelerated in progress than last year. Lots of new things, lots of new possibilities…we really are all pushing together and trying to get to the top of the mountain.”
With those words, Dr. Web Cavenee of Ludwig Cancer Research began his recap of the 2017 National Brain Tumor Society Scientific Summit during the program’s wrap-up session and closing remarks.
Dr. Cavenee, a pioneer in the field of brain tumor research, went on to highlight a dozen questions that arose from the day’s candid and open set of conversations among top minds from different sectors of neuro-oncology. These discussions ranged between a number of the most pressing issues, challenges, and opportunities facing the field and how to move forward toward better treatments and cures.
Dr. Cavenee offered that these questions were extremely important to the field’s potential future progress, could be used as “action items,” and that they could perhaps be addressed “relatively quickly, and would really increase our ability to move forward.” He likened the field’s prospective pursuit of these questions to plotting a “new map” for greater progress for patients – borrowing a metaphor used in an earlier discussion led by his colleague at the Ludwig Institute for Cancer Research, Dr. Paul Mischel, regarding his paradigm-shifting ecDNA discovery.
SESSION 1 – Tackling Adversity: Heterogeneity and Tumor Evolution
Drs. Joseph Costello (University of California, San Francisco), Bradley Bernstein (Massachusetts General Hospital and the Broad Institute of Harvard and MIT), Cavenee, and Kristin Swanson (Mayo Clinic)
Incorporating the program’s Keynote Presentation by Dr. Bernstein on how genetic and epigenetic factors converge to drive the evolution of glioma brain tumors, this session examined the various factors that could be driving and/or contributing to how tumors acquire differing sets of mutations and other molecular alterations over time and, potentially, as a response to treatment. This evolution and heterogeneity makes gliomas, particularly high-grade gliomas like glioblastoma, very complex and very difficult to treat.
Based on the dialogue and highlights from the panel, Dr. Cavenee queried:
SESSION 2 – Tackling Adversity: Signaling and Tumor Metabolism
Drs. Mischel, Ingo Mellinghoff (Memorial Sloan Kettering Cancer Center), and Sriram Venneti (University of Michigan)
This session discussed how different mutations and alterations commonly found in gliomas can actually “re-wire,” or “re-program,” various other elements of a glioma cell’s environment and functions, including the cell’s metabolism and microenvironment (surrounding blood vessels and other types of cells). This can include changing how, and how much, glioma cells gobble up nutrients to fuel their growth. Glioma cells have been found to become dependent or “addicted” to these nutrients – which would have important implications for developing new treatment strategies. Finally, this discussion led to the potential importance of where these mutations and alterations are found within cells (again, the ecDNA topic mentioned above), and how that could relate to treatment resistance in glioma patients.
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These observations begged the following questions:
SESSION 3 – Maximizing Opportunities: Therapeutic Strategies and the Blood-Brain-Barrier
Drs. Patrick Wen (Dana Farber Cancer Institute), Howard Fine (Weil Cornell Medical Center), Alan Olivero (Genentech), Kathy Warren (National Cancer Institute)
The blood-brain-barrier is our body’s natural protection to prevent potentially harmful toxins, pathogens, and chemicals from entering this vital organ. However, when it comes to treating tumors in the brain, this also means that it is hard for many traditional anti-cancer drugs to even get into the brain and to the tumor, as most are specifically designed not to get in. Therefore, it is important for the field to better understand if a drug can ever reach its target at a potent enough concentration to have the therapeutic effect that is intended before a lot of resources are devoted to it in a large clinical trial.
SESSION 4 – Maximizing Opportunities: Immune System and Immunotherapy
Drs. David Reardon (Dana Farber Cancer Institute), Michael Lim (Johns Hopkins), Cassian Yee (MD Anderson Cancer Center)
According to Dr. Reardon, a brain tumor immunotherapy expert, there are already nine different immunotherapies approved by the FDA to treat certain types of cancers. Specifically, these drugs are currently approved of use in 13 different cancers. Unfortunately, malignant brain tumors are not one these 13 cancers that have seen an approval for one or more of these nine cutting-edge treatments. This session discussed some potential reasons why immunotherapies have yet to demonstrate significant or widespread success in neuro-oncology, as well as potential strategies to boost and enhance the effectiveness of these types of treatment for brain tumor patients.
Following the Summit, Dr. Al Yung of MD Anderson Cancer Center and National Brain Tumor Society’s Distinguished Scientific Advisor, who facilitated the Summit’s scientific program, compared Dr. Cavenee’s set of questions (or, really, action items) to, “a guide for a national agenda for the next few years for brain tumor research funding.”
In addition to the panelists, presenters, and speakers, the Summit featured roughly 100 other leading experts from across sectors of brain tumor and brain cancer research – government, industry, academia, biomedical and scientific research, patients, and advocates – sharing a room with the sole purpose of addressing the biggest barriers to discovering and developing new treatments and a cure.
The four panels and discussion topics represented areas of major importance to bridging the gap between science and increasing patient survival, shaped the day’s agenda and conversations. These sessions included a morning program of robust conversations on critical areas impeding progress that the field is attempting to deal with as a whole, followed by the afternoon sessions looking at some of the most promising areas of research to address unmet needs in neuro-oncology.
This year’s Summit was particularly impactful, as it generated collective ideas and areas of focus to move this field forward to discover and develop much needed new and better treatments for brain tumor patients.Attribution: Dr. Yung
NBTS’ CEO, David Arons, weighed in further in a press release following the Summit, saying, “We were encouraged with the level of dialogue and debate, and believe the day’s program offered a glimpse at the real, tangible progress being made currently in the field, as well as identified the key barriers that still need to be addressed in order to find a cure for many types of brain tumors.”
Following the main scientific program, a “poster” session was combined with a reception to allow for more sharing of information and discussion. Scientific poster presenters included NBTS-funded researchers: Drs. Frank Furnari (Ludwig Cancer Research), John de Groot and Erik Sulman (MD Anderson Cancer Center), Mellinghoff, Mischel and Tim Cloughesy (UCLA), Daniel Brat (Northwestern), Elizabeth Claus (Yale/Brigham and Women’s Hospital), Robert Jenkins (Mayo Clinic), Roel Verhaak (Jackson Laboratory); and Michael Prados (University of California, San Francisco).
The Summit then concluded with a dinner program and awards ceremony. Honored during the awards ceremony were, 2017 NBTS Achievement recipients: