Team-Based Approach Tackles the Deadly Diagnosis of Glioblastoma

Glioblastoma is the most common and aggressive form of malignant brain tumor in adults. A glioblastoma diagnosis can feel overwhelming and the prognosis difficult to hear. But alongside the uncertainty, there are facts worth knowing: Research is accelerating, new treatment approaches are emerging and supportive care options are helping patients and families navigate each step with greater clarity and strength.

The multidisciplinary brain tumor team of Baptist Health Miami Cancer Institute and Baptist Health Miami Neuroscience Institute delivers advanced therapies tailored to each patient’s specific needs, balancing aggressive treatment with quality of life.

“Whenever someone is diagnosed with glioblastoma, given how aggressive this tumor is and the number and types of interventions that are required to treat it, we always talk about things like prognosis, longevity and what a patient’s goals or wishes are,” explains Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis program at Miami Cancer Institute. “We obviously want to provide the patient the best long-term survival possible, but we also want to integrate our efforts into the patient’s life.” 

What Is Glioblastoma?

Glioblastoma (sometimes called glioblastoma multiforme or GBM) develops from glial cells — the supportive cells in the brain that normally help neurons function properly. What makes it so challenging is its tendency to invade surrounding brain tissue.

“Glioblastoma is a grade 4 brain tumor. That is the highest on the spectrum, the most aggressive of tumors that start in the brain,” Dr. Kotecha says. “It’s the fastest-growing tumor. It has been there the shortest period of time before a patient has symptoms and requires the most aggressive interventions.”

Even with advances in cancer care, the prognosis for glioblastoma has not improved significantly. With treatment, patients typically survive just 15-18 months beyond diagnosis. About 25 percent of patients survive two years, and less than 5 percent survive five years or longer.

Glioblastoma in the News

Glioblastoma has been in the headlines recently with Grammy Award-winning singer Michael Bolton’s media revelations about his treatment. After celebrated conductor Michael Tilson Thomas was diagnosed, he stepped down as artistic director of South Florida’s New World Symphony, which he founded; recently, he announced he also would retire from the San Francisco Symphony, following a recurrence despite aggressive treatment and two brain surgeries.

Glioblastoma is the same cancer that claimed Beau Biden, the son of President Joe Biden, as well U.S. Senators John McCain and Ted Kennedy. The U.S. Senate voted unanimously to designate the third Wednesday in July as Glioblastoma Awareness Day to bring attention to this disease. Approximately 15,000 Americans are diagnosed each year.

Symptoms can vary widely from patient to patient but can include headaches, changes in vision, nausea, disorientation and difficulties speaking. As there is no screening for this cancer, by the time symptoms appear and patients consult their doctor, glioblastoma may be advanced.

Diagnosing and Treating Glioblastoma

Standard treatment for glioblastoma usually involves a combination of approaches. When possible, neurosurgeons work to remove as much of the tumor as possible. Complete removal, or resection, is typically not possible because these tumors have finger-like projections that infiltrate nearby brain tissue. Some tumors are located near critical brain areas that control essential functions.

“A maximal safe surgical resection is the first step. It is both diagnostic, to provide us information on the type of tumor, but also therapeutic,” Dr. Kotecha explains. “Once we have the pathology and the molecular profile of the tumor, we can confirm the diagnosis and start the rest of the treatment.”

Following surgery, radiation treatments typically target the tumor site and surrounding margin of tissue. Modern radiation therapy uses highly focused beams to minimize damage to healthy brain tissue.

Temozolomide (also known by the brand name Temodar) is the standard chemotherapy drug for glioblastoma. The drug damages the DNA of cancer cells, preventing them from dividing and growing, explains Yazmin Odia, M.D., chief of neuro-oncology and director of the Brain Tumor Program at Miami Cancer Institute and Baptist Health Miami Neuroscience Institute.

“Temozolomide remains the standard and most effective medical therapy for glioblastoma since the landmark trial published in 2005,” Dr. Odia says.

The complexity of glioblastoma lies in its genetic diversity. A single tumor can contain multiple types of cancer cells with different mutations, making it hard to target effectively. Moreover, the brain’s natural defense — the blood-brain barrier membrane — impedes many drugs from reaching the tumor.

Precision Treatments from a Multidisciplinary Care Team

Research continues to advance the understanding and treatment of glioblastoma. Scientists are developing precision medicine approaches that target specific genetic alterations in tumors, including immunotherapy strategies that help the body’s immune system fight the cancer.

“New tools to better determine and predict response to available medical therapies are helping guide neuro-oncologists in selecting the right therapy for each specific patient,” Dr. Odia explains. Researchers are also finding better ways to cross the blood-brain barrier to deliver drugs more effectively.

“Seeking care at comprehensive centers like Miami Cancer Institute and Miami Neuroscience Institute can provide access to neurosurgeons who specialize in brain tumors, multidisciplinary tumor boards that review complex cases, advanced treatment options, clinical trials and comprehensive support services,” says Vitaly Siomin, M.D., director of cerebrovascular surgery and co-director of skull base surgery at Miami Neuroscience Institute. “As a neurosurgeon, I believe a team-based approach — one that includes a neuro-oncologist and a medical oncologist who treat only brain tumor patients every day — is invaluable.”

Increasing Hope Through Clinical Trials

One of the best ways for patients with glioblastoma to access cutting-edge treatments is through participation in clinical trials. Many new therapies — immunotherapies, vaccines and targeted drugs — are currently being evaluated across the world.

While a cure for glioblastoma remains elusive, each scientific breakthrough brings physicians closer to transforming this diagnosis into a treatable — and eventually survivable — condition.

According to Dr. Kotecha, hope lies in the determination of researchers, doctors and patients working together to challenge the limits of what is currently possible. It resides in new therapies that may not yet be widely available but are progressing through trials that seek to change the paradigm of care.

Most importantly, he says, hope lies in the resilience of patients and families who face this diagnosis with courage.

“We really learn from them — from how strong they are and from what they have to go through with the surgeries, the courses of radiation, the different systemic therapies, the combination treatments, as well as the fact that they’re enrolled in trials,” Dr Kotecha says. “Sometimes these are early, phase one safety profile studies. Sometimes they’re longer phase two studies, or they’re randomized phase three studies and then we don’t know whether the patients are receiving a placebo or an active agent. We really appreciate everything that our patients go through to be able to allow us to treat them, but also to allow us to learn from them.”

Recent advances — from targeted therapies to immunotherapy and AI-driven diagnostics — offer patients and families more than just time, says Dr. Kotecha. They are offering possibility.

“While we haven’t seen a lot of progress in life expectancy, we’ve learned a lot from these trials,” Dr. Kotecha says. “Future clinical trials are being designed to have more advanced, personalized, biologically targeted radiation therapy. Instead of using just an anatomic MRI scan alone to identify the areas of disease, we’re integrating more advanced imaging studies that can help us boost areas that could be areas of recurrences in the future.”

Research Explores Multiple Avenues for Progress

Miami Cancer Institute researchers have received a prestigious $3.4 million R01 grant from the National Institutes of Health and the National Cancer Institute to further research into glioblastoma. The project, “Quantitative Imaging Phenotype Classifier for Distinguishing Radiation Effects from Tumor Recurrence in Glioblastoma,” aims to help distinguish between brain cancer progression and changes caused by the inflammatory process in the brain.

“Research such as this drives the revolutionary change necessary to improve the quality of our patients’ lives and to extend their survival,” says Manmeet Ahluwalia, M.D., MBA, FASCO, the study’s co-principal investigator. He holds the Fernandez Family Foundation Endowed Chair in Cancer Research, as well as serving as chief of medical oncology, chief scientific officer and deputy director of Miami Cancer Institute and Baptist Health Cancer Care.

Dr. Ahluwalia also is leading a multicenter study that is using low-intensity focused ultrasound to perform a liquid biopsy of a brain tumor. During the procedure, the blood-brain barrier is temporarily disrupted, allowing tumor DNA to leak into the bloodstream, where it can be detected in a blood test.

Additional studies are examining whether dose-escalated proton therapy might be more effective than traditional photon radiation, and whether radiation delivered more slowly over time might be safer for the brain, especially for those who already have undergone previous radiation treatment and are dealing with a recurrence. “We’re already testing this at Miami Cancer Institute,” Dr. Ahluwalia says. “The hope is that it allows the brain to absorb radiation a second time and minimize the toxicity associated with the treatment.”

Dr Kotecha also is leading a phase II trial testing whether a combination of immunotherapy medications and radiation therapy will improve the body’s ability to attack the cancer cells, helping to shrink or to stabilize the cancer better than radiation therapy alone.

“Hopefully we can push the envelope and improve the survival for our patients,” Dr. Kotecha says.

Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis program at Baptist Health Miami Cancer Institute

Yazmin Odia, M.D., chief of neuro-oncology and director of the Brain Tumor Program at Baptist Health Miami Cancer Institute and Baptist Health Miami Neuroscience Institute

Vitaly Siomin, M.D., director of cerebrovascular surgery and co-director of skull base surgery at Baptist Health Miami Neuroscience Institute

Manmeet Ahluwalia, M.D., MBA, FASCO, the study’s co-principal investigator. He holds the Fernandez Family Foundation Endowed Chair in Cancer Research, as well as serving as chief of medical oncology, chief scientific officer and deputy director of Baptist Health Miami Cancer Institute and Baptist Health Cancer Care