New Hope for Brain Cancer Treatment with Dr. Kathryn Beal

Faith: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

A diagnosis of a tumor in the brain can feel scary and daunting. But with new advances in treatment, patients have more options than ever. To discuss the latest breakthroughs in brain cancer treatment, I talked with Dr. Kathryn Beal, a radiation oncologist at NewYork-Presbyterian and Weill Cornell Medicine. She explained the differences between a brain tumor and brain cancer, defined glioblastomas, and explained why she’s optimistic for the future of brain cancer treatment, including glioblastoma. 

Faith: Dr. Kathryn Beal, I’m so glad you’re here.

Dr. Beal: Thank you. I’m so pleased to be here, Faith.

Faith: So we’re here today to better understand a diagnosis that sounds very scary, brain cancer. But this is something you treat everyday, and I know we’re going to be talking about some hopeful advances in your field. Before we do, can you start by telling us a little bit more about the different types of brain cancer?

Dr. Beal: So a cancer generally means something that is growing out of control, typically invades whatever organ it starts in. If you have a cancer starting in the brain, those cancer cells keep dividing and invade actually into the healthy brain tissue. And then most cancers in your body can, cells can break off and spread to other organs, and that would be metastases. So that’s a spread of that cancer into other organs.

So in doctor terms, we don’t really say “a cancer of the brain.” We would use the specific word to describe the tumor or the cancer. So if a lung cancer spreads to the brain, it’s still lung cancer, and the drivers behind that lung cancer are the same whether they’re in the lung or the liver or in the brain. Um, versus a brain cancer would really mean a cancer that’s starting in the brain and those unfortunately are in general quite aggressive with a few exceptions.

So for instance, a glioma is a tumor that arises from the glial cells. “Glial” means glue in Greek, so, the brain tissue is composed of neurons, which are the nerves, or the, the computer system, that sends all the messages to each other, and then it also has a huge supporting network of glial cells. And those glue cells are actually the cells that gliomas, including glioblastomas, arise from. So a doctor would say to another doctor, “this patient has a glioma.” The one that many people have heard of is something called a glioblastoma. And those are typically relatively rapidly progressive, and profoundly dramatic for the patient and family members.

So the good news about glioblastomas is that, we have a much better understanding of glioblastomas today than we did even 10 years ago, and there’s, there are so many clinical trials and scientific trials, preclinical trials, meaning in the lab going on with many different approaches, including different medical approaches, to try to attack these tumors. We have a few patients who are doing much, much better than they might’ve even 10 years ago by adding some of these therapies. And we have some patients who are massive outliers and can live for many years with this disease.

Faith: And Dr. Beal, today happens to be Glioblastoma Awareness Day.

Dr. Beal: Yes, yeah. 

Faith: What do you want people to know generally about brain cancer and brain tumors? Because they’re, they’re not always synonymous.

Dr. Beal: They’re not synonymous. That’s a very good point. Patients will sometimes use the word brain cancer when they actually mean a brain tumor. So a tumor that starts somewhere around the brain but not from the brain tissue or parenchyma. So there’s many elements inside your skull. So your skull has your brain. It also has the lining around the brain and tumors like to form along that area as well. So there are different types of tumors that can arise on that wrapping around the brain and those tumors tend to be benign. So those are actually more common than tumors that arise from the real brain tissue. And those tumors are almost always benign. 

Faith: Are there any things we can do to prevent brain cancer? You know, we hear so often about exercise, diet, sleep, fiber. Are there any choices we can make with our lives that have any effect on the likelihood?

Dr. Beal: All those things you just mentioned, sort of health hygiene, keeping your immune system strong by doing all of those activities and having a careful diet, are really the best thing you can do.

One thing overall that we know is that our immune system is very responsible for whether or not we develop a cancer that’s out of control or not. So there’s a whole class of drugs now called immunotherapy in general, but basically what they do is they help you upregulate your immune system. And those drugs work especially well when there are cancers that are very, very aggressive. So if the cancer is very aggressive, it doesn’t look like your own body, right? So if your immune system’s revved up, it will attack those aggressive cells.

Keeping your immune system healthy is probably the most important thing we can do for cancer protection in general.

Faith: What are the main ways of detecting cancer in the brain?

Dr. Beal: So if you have a high risk cancer or cancer that’s likely to go to the brain like lung cancer is the most likely cancer to go to the brain. So if you have lung cancer that’s aggressive, their oncologist will send that patient for typically an MRI to look for brain metastases. And we often find brain metastases and patients are completely asymptomatic. So they don’t have any symptoms, they don’t know they have those brain metastases, but we know they’re at high risk so the oncologist will order a screening MRI. And if brain metastases are identified, he or she will then refer the patient to somebody like me and I’ll assess the patient and typically I do recommend treatment for those brain metastases.

Faith: Are there any ways for patients to detect it themselves?

Dr. Beal: Obviously, if somebody presents with new seizures or a terrible headache that’s new or a new neurologic deficit, like a change in what we call visual field or even I’ve had a patient present interestingly with significant personality changes, anything that’s a big change. For primary brain tumors, there’s not any sort of particular screening test we do for them. 

Faith: Are there different treatments for cancers that start in the brain versus the cancers that spread to the brain?

Dr. Beal: If you have a very small tumor in the brain we can use a very high dose of radiation to a tiny little area when it’s just solid tumor that we’re treating. And we call that stereotactic radiosurgery. It’s not surgery with a knife where you’re cutting somebody open, we don’t need anesthesia for it. But it’s called surgery because it’s very precise and accurate, just like you would be if you had a scalpel in your hand and you were cutting out a tumor. We’re using huge obliterative doses of radiation, and this is best suited for smaller tumors, which are most often brain metastases.

For cancers that start in the brain, like a, like a glioblastoma, for instance, they mix into the normal brain tissue. They also tend to be relatively large. So with those types of tumors, we give a low dose of radiation every day, Monday through Friday, five days a week for six weeks. Specifically for glioblastomas. You damage the DNA of those cancer cells with radiation, their repair systems aren’t very good. So they die preferentially versus the normal healthy cells will get some damage from the radiation, but they have good repair capabilities. And so we find a balance of enough treatment to kill the majority of the cancer cells while sparing the normal healthy cells that are admixed in there. 

Faith: How do you know when you’re finished? How do you measure success?

Dr. Beal: The gold standard, ultimately, is an MRI that we get usually about a month after. And that’s the first indication we’ll have in terms of how well a tumor has responded to radiation. 

Faith: When folks make an assumption that your focus must be depressing for you, what are they getting wrong?

Dr. Beal: In the past decade in particular, there’s been a massive improvement in our understanding of cancer in general. And for each type of cancer in our body, we have a much better understanding of the biology and the drivers of those cancers. And with that understanding, we are developing better targeted approaches.

And many of those targeted approaches relate to different types of drugs we give. So some of them are classic chemotherapies, and then there are also a whole new class of drugs that are very targeted just to a specific mutation that drives a cancer. And then finally, we also have a whole new field of immunotherapy. So drugs that help stimulate your body’s own immune system attack the cancer. With the advent of all of these new drugs, we’re seeing much better outcomes for patients with advanced cancer, including patients who have spread of cancer into the brain.

And so we now have a whole group of patients who have survived their brain metastases, and those are the most common brain tumors we see. And with a combination of drugs that control the disease very well in the body in combination with stereotactic radiosurgery, we can cure a lot of these patients who have spread of cancer to their brain.

Faith: You just use the word cure!

Dr. Beal: Cure! Cure. It’s true. Cure. I’ve got a whole clinic full of patients I see every few months who get MRIs and I’m absolutely delighted to tell them their brain MRI is normal, um, and they’re cured and there’s really no better message to give a patient, um, and no better feeling as a doctor to be able to tell somebody they’re cured.

Faith: You mentioned that Glioblastomas are more aggressive, and at this time there’s no known cure. What is your message to patients and their families who receive a glioblastoma diagnosis?

Dr. Beal: It’s not an easy situation for anyone. There’s a large range of possibility with those patients in terms of how long they’ll survive, but I find that being not only empathetic but straightforward and, and answering patients questions as much as they want to know. Some patients want to know everything. Some patients don’t want to know much. They want to just be taken care of. It’s my, my privilege and my pleasure to do that.

I think it’s very important for every patient when they come in for any appointment with the doctor, to come with anyone, a friend, a spouse, a family member to ask questions, to have a second set of ears.

Our understanding of the science is skyrocketing at a big rate. Our translation into sort of therapeutic advantages is accelerating at a much slower rate, but we have a much greater insight into how and why patients develop glioblastomas. We also have a much higher understanding of what we can do to rev up our immune system to help attack tumors in our brain. 

I always try to leave some hope. Treatment essentially always extends life and most of the time, will alleviate symptoms and improve quality of life.

Faith: Dr. Kathryn Beal, Thank you for, thank you for teaching us so much and ultimately leaving with a message of hope.

Dr. Beal: Yeah, absolutely. Absolutely. It is a message of hope.

Faith: Our many thanks to Dr. Kathyrn Beal. I’m Faith Salie. 

Health Matters is a production of New York Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. NewYork-Presbyterian is here to help you stay amazing at every stage of your life.

To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.