Research in brain and spinal cord tumours

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat brain and spinal cord tumours. They are also looking for ways to improve the quality of life of people with brain and spinal cord tumours.

The following is a selection of research showing promise for treating brain and spinal cord tumours.

We’ve included information from the following sources. Each item has an identity number that links to a brief overview (abstract).

• PubMed, US National Library of Medicine (PMID)
• American Society of Clinical Oncology (ASCO)
• Canadian Cancer Trials and ClinicalTrials.gov (NCT)

Brain and spinal tumours that can be completely removed have a better prognosis. Researchers are looking for ways to improve surgical techniques to remove brain and spinal cord tumours, without destroying important tissue or affecting brain or spinal cord functions.

Intra-operative imaging techniques are tools that help doctors see inside the body during surgery. Researchers are studying these techniques to see if they can be used to help doctors plan treatment and guide them during surgery for brain and spinal cord cancer. It is hoped that by being able to see the difference between the tumour and brain tissue, the surgeon can remove as much of the cancer as possible, while saving the normal brain tissue (Cochrane Database of Systematic Reviews, PMID 29355914; International Journal of Computer Assisted Radiology and Surgery, PMID 28391583).

Fluorescence-guided surgery uses drugs that glow when exposed to light. The drugs are given by mouth, and cancer cells take up more of the drug than normal cells because they are growing faster. During surgery, the surgeon uses a microscope with a special blue light attached to it. The cancer cells light up under the light so the surgeon can see them easily and remove as much of the tumour as possible. Fluorescence-guided surgery is being studied for its role in surgery for some types of brain tumours (Neurosurgery Clinics of North America, PMID 28917285; NCT01502280). A recent small study suggests that fluorescence-guided surgery may work better for high-grade brain tumours than low-grade tumours (British Journal of Neurosurgery, PMID 29357709).

Radiation therapy is a standard treatment for many types of brain tumours. A key area of research is looking at better ways to treat brain and spinal cord tumours with radiation therapy.

Proton beam therapy uses protons (positively charged particles) to treat cancer. Protons release more energy after reaching a certain distance and then stop, causing the least amount of damage to nearby normal tissues. Proton beam therapy may be a good treatment option for tumours in the base of the skull, as these can be difficult to remove with surgery and standard radiation therapy (Seminars in Radiation Oncology, PMID 29735196; Current Treatment Options in Neurology, PMID 28365895).

A clinical trial is comparing using chemotherapy along with proton beam therapy, standard external beam radiation therapy or intensity modulated radiation therapy. The study hopes to find out if proton beam radiation therapy has fewer side effects than the other types of radiation treatment and if it improves overall survival and progression-free survival (NCT02179086).

Researchers are looking for ways to improve chemotherapy as a treatment for brain and spinal cord tumours. 

An implant using low intensity pulsed ultrasound is being tested to see if it can allow drugs to get to a brain tumour by disrupting the blood-brain barrier and in doing so improve the effectiveness of chemotherapy. A small study with recurrent glioblastoma multiform found that people who had clear evidence of blood-brain barrier disruption had a slightly improved overall survival than people who did not have blood-brain disruption. More study is being done in clinical trials (ASCO, Abstract 2016).

Targeted therapy drugs target specific molecules (usually proteins) that cause cancer cells to grow. To date, very few targeted therapy drugs have shown any effectiveness in improving survival in people with brain tumours. Researchers continue to look for targeted therapy drugs as a treatment for brain and spinal cord tumours.

Regorafenib (Stivarga) is a tyrosine kinase inhibitor. These drugs block a specific enzyme (called tyrosine kinase) that helps send signals within cells. When this enzyme is blocked, the cells stop growing and dividing. A clinical trial compared lomustine (CeeNU, CCNU) with regorafenib in people who had glioblastomas that had returned after treatment (relapsed). Results showed that regorafenib improved overall survival and progression-free survival  when compared to lomustine (ASCO, Abstract 2047).

Immunotherapy uses the immune system to help destroy cancer cells. A key area of research is looking at better ways to treat brain and spinal cord tumours with immunotherapy. In particular, different types of cancer vaccines are showing promise (Seminars in Immunopathology, PMID 28138787; Nature Reviews Neurology, PMID 28497804; Cancer, PMID 27875627).

CAR T-cell therapy takes millions of T cells from a person with cancer. In the lab, they are changed so they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific antigen (protein) found on the type of cancer being treated. The T cells are then given back to the person where they multiply, attack and destroy the cancer cells. Researchers are looking at using CAR T-cell therapies to treat glioblastoma (Clinical Cancer Research, PMID 29158268).

Researchers are looking at different ways of treating brain and spinal cord tumours. A key area of research is looking at alternatives to the surgical removal of tumours.

Laser interstitial thermal therapy (LITT) is a type of ablation treatment. The doctor places a probe in the tumour. The probe gives off light energy. Light energy is changed into heat energy in the tumour, which destroys cancer cells. Studies show that LITT is effective in treating gliomas that are difficult to remove with surgery. It may also temporarily disrupt the blood-brain barrier, which means that drugs could easily reach the brain when the LITT is being used (World Neurosurgery, PMID 29410102; Progress in Neurological Surgery, PMID 29990970; British Journal of Neurosurgery, PMID 29357709).

Irreversible electroporation uses electric pulses to destroy cancer cells. The advantage of this type of treatment is that heat isn’t used, which may mean less damage to the nerves, blood vessels and other tissues near the tumour. Research is still looking at the role that irreversible electroporation may have as a treatment for glioblastoma (Glioblastoma, PMID 29251858).

Interstitial photodynamic therapy uses drugs that glow when exposed to light. The drugs are given by mouth, and cancer cells take up more of the drug than normal cells because they are growing faster. The surgeon uses a special light to find the cancer cells. This is similar to fluorescence-guided surgery, but the light is used to destroy the cancer cells during interstitial photodynamic therapy. A very small study has found that interstitial photodynamic therapy is only successful if there is a large concentration of the light-sensitive drug in the brain tumour (Cancers (Basel), PMID 28125024).

High-intensity focused ultrasound (HIFU) uses focused ultrasound waves to create intense heat, which destroys tissue. Often an MRI is used to guide the ultrasound beam. Researchers are looking at HIFU as a treatment for gliomas (NCT01473485). It may also temporarily disrupt the blood-brain barrier, which means that drugs could easily reach the brain during this time period, and may make tumours more sensitive to radiation therapy (Progress in Neurological Surgery, PMID 29990972).

Researchers continue to try to find out more about brain and spinal cord tumours. Clinical trials are research studies that test new ways to prevent, detect, treat or manage brain and spinal cord tumours. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for brain and spinal cord tumours were first shown to be effective through clinical trials.

Find out more about clinical trials.