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How Our Patients Perform : Glioblastoma Multiforme [GBM]
Overall survival rates and a realistic evaluation of how UCLA Neuro-Oncology cares for patients with a Glioblastoma Multiforme
What is a Glioblastoma Multiforme
What is the Average Survival of a Newly Diagnosed GBM Patient treated by UCLA Neuro-Oncology
What are the first steps of treatment for a Glioblastoma Multiforme tumor
What chemotherapy agents does UCLA Neuro-Oncology use to treat patients with a Glioblastoma Multiforme tumor
How much experience does UCLA Neuro-Oncology have treating Glioblastoma Multiforme patients
What are the Advantages of being treated at a University Medical Center
What CLINICAL TRIALS are available for Glioblastoma Multiforme Patients
How do I Refer a Glioblastoma Multiforme Patient to UCLA
What is Glioblastoma Multiforme tumor?
(GBM) is the highest grade glial tumor and most common in the astocytic line. The tumor is characterized as an anaplastic often cellular brain tumor composed of poorly differentiated cells that include occasional multinucleated giant cells. Essential for the histologic diagnosis is the presence of prominent vascular proliferation and/or necrosis (WHO classification). The presenting symptoms for GBM include headache, seizures, mental status changes, or other focal neurologic deficits. The duration of symptoms is often short - weeks to months.

Diagnosis is usually made by non-invasive imaging, MRI and/or CT. On CT, high grade astrocytomas is seen as an enhancing hypodense or isodense lesion, usually surrounded by vasogenic edema. On CT and MRI, GBM is characterized by a thick and irregular enhancing rim of living tumor surrounding a hypodense (on CT) or non-enhancing (on MR) region. This non-enhancing region is consistent with necrosis within the mass. Hemorrage may also be present. High grade astocytomas can appear in any region of the brain, and they tend to invade into white matter tracts and can infiltrate the corpus callusom to involve both cerebral hemispheres

Gilroy, John. Basic Neurology 3rd ed. Wayne State University Press, 1999. 193-210
Wen PY, Fine HA, Black PM, Shrieve DC, Eben A, Loeffler JS. High Grade Astrocytomas. Neurologic Clinics 13: 875-892, 1995

What is the Average Survival of a Newly Diagnosed Glioblastoma Multiforme Patient treated by UCLA Neuro-Oncology?
There are several key factors that influence overall survival of a Glioblastoma Multiforme patient, these include initial diagnosis, number of times the tumor has recurred, patient age, molecular diagnostic results, past therapy, Karnofsky Score, tissue features, along with 50-60 other key variables. It is the job of the Neuro-Oncologist to take into account all factors and formulate the best option for you and your family.

Although it can be difficult to predict survival using just a single variable of pathology diagnosis, in general the following represents the average overall survival of Initially Diagnosed GBM patients treated by UCLA Neuro-Oncology. The patients represented all have started treatment ON or AFTER 4/27/2010.

Kaplan-Meier Plot (Est. Survival)

The Kaplan-Meier, estimates the survival function from life-time data. In the research setting it's used to measure the fraction of patients living from the time of initial diagnosis.

A plot of the Kaplan-Meier estimate of the survival function is a series of horizontal steps of declining magnitude which, when a large enough sample is taken, approaches the true survival function for that population. The value of the survival function between successive distinct sampled observations ("clicks") is assumed to be constant.

An important advantage of the Kaplan-Meier curve is that the method can take into account "censored" data — losses from the sample before the final outcome is observed. On the plot, small vertical tick-marks indicate losses, where patient data has been censored. When no truncation or censoring occurs, the Kaplan-Meier curve is equivalent to the empirical distribution.

* Published: Thursday, April 27, 2017 : 5:12:13 AM PT

What are the first steps of treatment of a Glioblastoma Multiforme tumor?

There are important first steps a patient must take in order to maximize the chances of survival and a successful therapy.
First Steps of Treatment:
Dr. Timothy Cloughesy explains the first steps of Neuro-Oncology Care, and outlines UCLA's Multi-disciplinary approach to effectively treat brain tumor patients

First one needs to clarify and confirm the pathologic diagnosis. This pathologic diagnosis is made based on the tissue obtained from the initial surgery. Going forward, the treatment plan will be created based on this diagnosis. This formal diagnosis is made by the neuro-pathologists and is the most important piece of information of any treatment plan.

It is important to note that it is critical to save all tumor tissue collected at the initial surgery. Not only for pathologic diagnosis but also many clinical trials down the road will require frozen tissue from the initial surgery.

Next we want to make sure the pathology diagnosis matches what we see on the MRI scan and what is going on with the patient. Taking all of these data points into consideration helps us get a better picture of what is going on with the patient, and can help us better determine how to move forward.

Once we are sure about the diagnosis we can move forward with Treatment Options. Sometimes the treatment will include a more extensive surgery in order to maximize the total resection of the tumor. In higher grade tumors, treatment options can include Radiation Therapy alone, combination therapy of Radiation and Chemotherapy, or combination therapy of Radiation and Chemotherapy followed by additional Chemotherapy.

The decision of what therapy to administer is provided by the Neuro-Oncologists.

If traditional therapy fails in the newly diagnosed setting, additional therapy can be administered in the recurrent setting.

The treatment approaches in the recurrent setting mirror some of the options in the newly diagnosed setting. For example, we will need to identify if the patient needs additional surgery for de-bulking or further tumor resection. The neuro-oncologist will also need to identify if further radiation is needed. Most of the time in these recurrent settings additional systemic treatment will need to occur. These forms of treatment can be either standard chemotherapy agents or experimental therapies as part of an ongoing clinical trial.

What chemotherapy agents does UCLA Neuro-Oncology use to treat patients with a GBM tumor?
Because each patient's treatment plan is unique, therapy normally is dictated by several factors including a person’s age, Karnofsky Score and any previous therapy they have received. Advances in our molecular diagnostics lab is enabling us to better predict what agents will benefit a particular patient group. In general, the following is an overview of agents we used to treat our GBM patients during the past 24 months. This list includes all patients treated at UCLA Neuro-Oncology between 4/27/2015 and 4/27/2017.
• 5FC• Accutane Hoffmann-La Roche• AEE788 Novartis
• AMG 595• AMG-102• AMG-386
• AMG-595• Anti Neoplaston• AQ4N (Banoxantrone)
• AVANDIA (Rosiglitazone Maleate)• Avastin • Avastin (Bevacizumab) Genetech
• BCNU• BiCNU Carmustine• BMS-CA209143 NIVOLUMAB
• Carboplatin• CC-223• CC223
• CCI-779• CCNU• CCNU Lomustine
• CDX-110• CDX-110 (RINDOPEPIMUT)• Ceenu
• Celecoxib (Systemic)• Celldex• Chloroquine
• Chlorquine• Cilengitide (EMD 121974)• Cisplatin
• CPT -11 (CAMPTOSAR, Irinotecan)• CPT-11• Cytoxan
• Dasatinib (BMS-354825, Sprycel)• DC vaccine • DC Vax
• Dcvax• Dendritic Cell Therapy• Disulfiram
• Etoposide (Eposin, Etopophos, Vepesid)• GDC-0449• Gleevec (imatinib mesylate)
• GLIADEL Wafer• Hydroxychloroquine• Hydroxyurea
• IL-13• IMC-3G3• Immune Therapy
• Iressa (ZD-1839)• Irinotecan• Keytruda
• Lapatinib (GW572016)• LOMUSTINE• LY317615 (Enzastaurin)
• MEDI4736• Mefloquine• Memantine
• Metformin• Methotrexate for Cancer (Systemic)• Nilotinib
• Nivolumab• Novocure TTF Therapy• ONARTUZUMAB VS PLACEBO
• Optune• OSI-774• PCV
• Pembrolizumab• Procarbazine• RAD001 Novartis (mTOR inhibitor)
• Rapamycin (Rapamune, Sirolimus)• Rindopepimut• RMP-7
• RTA 744• Simvastatin• Sirolimus
• Sorafenib• SU-101• SU5416 Sugen
• Sulfasalazine (Azulfidine)• Sutent (Pfizer)• Tagrisso
• Tamoxifen• TARCEVA (erlotinib HCl)• Taxol
• TEMODAR Schering-Plough• TGF-B Anti-Sense• Thalomid (thalidomide)
• Topotecan (Systemic)• Valcyte• VB-111
• VEGF Trap• VEGF-Trap• Velcade
• Vincristine• Vorinostat (SAHA)• XL184
• XL765• yervoy• Zarnestra (tipifarnib)
• ZOCOR (simvastatin)

* Published: Thursday, April 27, 2017 : 5:12:13 AM PT

How much experience does UCLA Neuro-Oncology have treating patients with a Glioblastoma Multiforme tumor?
A patient's tumor can often change from a lower grade tumor to a high grade tumor within a period of 24 months. In general the number of patients we treat with a diagnosis of Glioblastoma Multiforme at the time of therapy, based on data covering 4/27/2015 to 4/27/2017 are as follows:

What is the demographic breakdown of Glioblastoma Multiforme patients treated by UCLA Neuro-Oncology?
In general the number of patients we have treated with a diagnosis of Glioblastoma Multiforme at the time of treatment, based on data covering 4/27/2015 to 4/27/2017 are as follows:

What are the Advantages of being treated at a University Medical Center.
University Medical Centers specializing in the treatment of brain tumors have several advantages over community treatment centers and most private hospitals.
Treatment at a University Medical Center:
Dr. Timothy Cloughesy explains the importantce of receving treatment at a University Medical Center and the critical advantage patients may gain.
One of the areas where patients receive a benefit is in the tumor resection. At UCLA, the neuro-surgical teams not only use the most advanced surgical tools and robotic assisted machines, but at UCLA they also use Intra-Operative MRIs.  An intra-operative MRI is important because it ensures the maximum amount of tumor will be safely removed.
Another area where patients receive a significant benefit is having access to the newest clinical trials and experimental therapies.  At UCLA, researchers and physicians work closely with drug companies and national consortiums to secure state of the art chemotherapy agents for our patients.  In most cases UCLA is one of the first institutions to conduct phase I/II clinical trials for these agents.
UCLA also aims to provide the best possible care by using a Multi-Disciplinary approach to therapy. This means that specialist in Neurology, Neuro-Surgery, Radiation Oncology, Neuro-Radiology, Pathology and Neuro-Oncology are all involved when formulating your treatment plan.
Another advantage that can not be over looked is that UCLA researchers and physicians who treat primary brain tumors sole focus is brain tumor patients. The UCLA Neuro-Oncologists and other members of our team are focused 100% on brain tumor patients. They are required to be leaders in the field in terms of research and clinical care. They are also required to attend national conferences and publish regularly on their findings. Their goal is not only to help treat patients with primary brain tumors, but also push science forward towards a cure.

What clinical trials are available at UCLA Neuro-Oncology?
Choosing to participate in a clinical trial is an important, personal decision. It is often helpful to talk to a physician, family members, or friends about deciding to join a trial. After identifying some trial options, the next step is to contact the study research staff and ask questions about specific trials.

For more information about any of the UCLA Neuro-Oncology Program’s clinical trials listed, please contact Emese Filka, Clinical Trials Coordinator, at (310) 794-3521

Study AgentIRB IDTrial:Details
MEDI473614-001460[Ludwig LUD2013-006]:
18-FDG16-000600Dr. Ellingson 18-FDG-PET (2016):
5-FC (Flucytosine)10-001147[Tg 511-09-01]:
ACP-19615-001667[Acerta ACE-ST-209]:
aCTL and IL-211-000790[aCTL Immunotherapy (Dr Liau)]:
CDX-110, Temozolomide11-002220[Celldex CDX110-05] :
Lapatinib (GW572016), TMZ, RT12-000493[Lapatinib_Nghiemphu]:
Nivo16-000365BMS CA209548:
Nivo16-000207BMS CA209-498:
Nivolumab, the combination of Nivolumab and ipilimumab14-000075[BMS CA209143]:
Toca 51115-001608[Tg 511-15-01]:
VB-11115-001545 VBL VB-111-215 :

How do I Refer a Glioblastoma Multiforme Patient to UCLA.

At UCLA Neuro-Oncology we aim to provide the very best possible patient care to you, and would like to make contacting us as pleasant and efficient as possible.

If you are a physician:

If you would like to directly refer a patient to us for care or consultation, or would like to discuss the care of a patient with us, please feel free to telephone our main office at 310.825.5321. To directly schedule a new patient for an appointment please contact the NEW PATIENT SCHEDULING LINE: at 310-206-6909.

If you are a patient:

If you are new to us and are seeking to schedule a clinical visit, 2nd opinion visit, or have your scans, tissue or other resource evaluated you will need to contact the NEW PATIENT SCHEDULING LINE at 310-206-6909 to set up an appointment.

If you have previously been seen by us at UCLA Medical Center please call the RETURN VISIT SCHEDULING LINE at 310-206-9260 and they can assist you with scheduling or re-scheduling an appointment

All Information content hearof is designed for educational purposes only and is not for the purpose of rendering medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. Any specific questions you may have regarding an individual's medical condition should be directed to the individual's primary care physician or other attending physician. In addition, if you have or suspect you may have a health problem, you should consult your health care provider.

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[Content Published:4/27/2017 5:12:13 AM PST]