Glioblastoma (GBM) is the most common brain tumour, the most lethal and difficult to treat. Standard treatment includes a combination of chemotherapy with temozolomide (TMZ) plus daily radiation treatment (RT) to the tumour for 6 weeks (known as the Stupp Protocol followed by further chemotherapy alone ). When delivered successfully, it can prolong average survival by a year or more. Unfortunately this is not a cure and in practice there is variable response to treatment including unwanted clinical toxicity (side-effects). Indeed, 1 in 4 people treated will experience such severe side-effects to their blood system that the protocol has to be interrupted or abandoned altogether; decreasing any chance of success. The problem is that there is currently no way to predict which patients will suffer this fate and which patients are best suited to an alternate therapy.
Thus the aim of this study is to use a combination of existing and novel clinical blood tests to predict which patients with GBM will suffer severe toxic side-effects when treated with the Stupp protocol. All of the tests we propose have been used for predicting patient outcomes in other treatments and other diseases, but this is the first time they will be combined and applied to treatment for GBM.
To do this we will collect blood before and during treatment from 50 patients undergoing the Stupp protocol at Calvary Mater Newcastle hospital. We will measure the amount of TMZ in their blood and correlate this with the toxicities they experience. We will also measure a unique set of biomarkers to tell us how their blood cells will respond to this treatment including the ability of their blood cells to repair the damage induced by the TMZ treatment and the ability of their blood cells to produce new healthy blood cells. These measures will tells how susceptible their blood cells are to the toxic effects of TMZ.
We anticipate that a combination of all or some of the results of these tests will be able to predict if a patient is at high or low risk of suffering severe toxicity to treatment before they start treatment. This will help both patients and carers decide what course of treatment they wish to take.
Annually there are 2,000 new cases of brain cancer in Australia. Prognosis for people with brain cancer is dire. It is the highest cause of death in 0-39 age group with a 5-year survival rate of 19%. Brain cancer results in 5,000 hospitalisations per year (average stay 12.5 days, the longest of any cancer) and has the highest lifetime cost per patient of $1.89m.