Marcus Ware

By Michael J. Strong and Marcus L. Ware

Central nervous system (CNS) tumors, although rare, represent a group of neoplasms that have a disproportionate morbidity and mortality. Despite advances in our understanding of tumor pathogenesis coupled with improvements in therapeutic options, overall survival for primary brain tumors remains dismal. Although challenging, newer approaches such as brachytherapy, immunotherapy, and electric field generators are currently being evaluated in the clinical setting with promising results. The field of immunotherapy in neurooncology is still in its infancy, but several advances have already been made, including the development of tumor vaccines, utilization of immune checkpoint inhibitors, and activation of tumor dendritic cells to stimulate the host’s immune system. Recent advances in noninvasive electric fields have been applied to the treatment of glioblastoma multiforme (GBM) with encouraging clinical outcome. In this chapter, we will review the latest advances in the treatment of glioblastoma multiforme with a focus on immunotherapy.

Part of the book: New Approaches to the Management of Primary and Secondary CNS Tumors

By Caleb Stewart, Brody Stewart and Marcus L. Ware

Metastatic brain tumors (MBTs) are the most common intracranial tumor and occur in up to 40% of patients with certain cancer diagnoses. The most common and frequent primary locations are cancers originating from the lung, breast, kidney, gastrointestinal tract or skin, and also may arising from any part of the body. Treatment for brain metastasis management includes surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and chemotherapy. Standard treatment for MBTs includes surgery and SRS which offer the best outcomes, while the WBRT is still an important treatment option for patients who cannot tolerate surgery and SRS or patients with multiple brain metastases. Newer approaches such as immunotherapy and molecularly targeted therapy (e.g., small molecules and monoclonal antibodies) are currently being evaluated for the treatment of MBTs. In this chapter, we will review current available treatments for MBTs and discuss treatments that are undergoing active investigation.

Part of the book: Brain and Spinal Tumors

By Lee Roy Morgan, Branko Jursic, Marcus Ware and Roy S. Weiner

Central nervous system (CNS) malignancies are rare, but commonly fatal and glioblastoma (GBM) is the most common of the primary brain tumors. In contrast to metastatic malignancies involving the CNS, which have external blood supplies that develop when the malignant cells penetrate the blood-brain-barrier (BBB), GBM generates its own intracerebral neovascular support system. Thus, the therapeutic issues as discussed herein review the development of drugs and therapeutics that will penetrate the BBB and are cytotoxic to GBM and other brain tumors. Since GBM is a CNS malignancy with minimal effective therapeutic options available, designing drugs and therapeutics as treatment for this malignancy that penetrate, but do not disrupt the BBB is the goal of this chapter. 4-Demethylcholesteryl-4-penclomedine (DM-CHOC-PEN) was designed and developed because of its lipophilic properties that would potentiate crossing the BBB and penetrate brain tumors. The drug has now completed Phase I/II clinical trial in humans with primary brain malignancies demonstrating objective responses in GBM. In addition, preliminary experiences with naturally occurring polyphenols—curcumin, quercetin, catechins and phloretin and derivatives—are reviewed as potential naturally occurring anti-glioblastoma agents.

Part of the book: Glioblastoma

By Lee Roy Morgan, Branko Jursic and Marcus L. Ware

Part of the book: Neurofibromatosis

By Tayler D. Payton and Marcus L. Ware

Patients diagnosed with neurofibromatosis type 2 (NF2) are likely to develop vestibular schwannomas, meningiomas, and other tumors that may be difficult to treat. These tumors and their locations can pose unique challenges for patients, caregivers, and medical providers. We describe a case of a patient with NF2 who presented with multiple tumors including bilateral vestibular schwannomas and multiple meningiomas. This case highlights the medical and surgical complexity of care of patients with NF2 and the need for ongoing surveillance by a multidisciplinary medical team. We also provide a brief review of literature focusing on NF2 and its treatment.

Part of the book: Neurofibromatosis