Five years ago, at age 67, Lynn Oxenberg had a seizure, which doctors found to be caused by glioblastoma (GBM), the most common—and most aggressive— type of cancerous brain tumor in adults. Individuals with GBM usually expect to live 15-17 months following their diagnosis. Doctors were able to remove the tumor and find a treatment that keeps her cancer from returning, but she still comes to Penn Medicine for regular scans to monitor her brain for signs of tumor progression—in other words, that the cancer has started growing again.
“When I was first diagnosed, every scan gave me anxiety, I would worry the cancer could come back, even more aggressively,” Oxenberg said. “I couldn’t plan more than a few days, maybe weeks into the future, for fear that the next time I came in for scans, I’d hear bad news. Even worse would be to hear that a scan was inconclusive and I had to come back in a month. I would worry I was losing time that could be used for treatments.”
Many patients with GBM and other cancers experience this sense of dread and vulnerability related to their scans, sometimes referred to as “scanxiety.”
“Unlike in other cancers, we can’t biopsy the brain every few months to monitor a tumor, and so we have to rely on scans, like MRI or PET,” said Suyash Mohan, MD, an associate professor of Radiology at Penn Medicine, specializing in neuroradiology. “Many patients are living scan-to-scan, hoping that their tumor is responding positively to treatment, but worried that it could return aggressively at any time. When their life expectancy is only a matter of months, every month counts in treating this challenging cancer.”
In an effort to more effectively assess a patient’s individual cancer, and provide personalized, targeted treatments, Mohan collaborated with Steven Brem, MD, a professor of Neurosurgery, and colleagues to develop the first-ever tool that gives a real-time assessment of the tumor.
Better Distinguishing Inflammation from Tumor Growth
While there is no known cure for GBM, many treatments—such as immunotherapy—can be effective. But treatments like these can also cause inflammation in the brain, which can show up on brain scans, like magnetic resonance imaging (MRI) or positron emission tomography (PET), as tumor growth, also known as pseudoprogression (PsP). This PsP is difficult to diagnose and makes it difficult to quickly and accurately determine treatment plans.
For example, GBM is often treated with surgery followed by a drug called temozolomide (chemotherapy), alongside radiotherapy. Patients who respond well to these therapies are sometimes offered to continue temozolomide as maintenance, to prevent the cancer from coming back. However, patients whose tumors progress after these initial treatments likely need second line therapies, including repeat surgery or explore other options such as clinical trials. But when it is unclear whether or not the tumor is progressing, it becomes more difficult to determine which next steps will be most effective for an individual patient.
The new tool Mohan and Brem created acts as a “thermometer” that simultaneously interprets multiple advanced MRI imaging sequences using artificial intelligence to read the response of a patient’s tumor to treatment, and generate a “score” at that given moment in time. Clinicians can then use this score, or “temperature,” to guide therapeutic decision-making. Because the “thermometer” receives input from a number of scan parameters, each measuring a unique physiologic or metabolic process, it is able to filter out the noise i.e., inflammation or other treatment related changes from viable tumor, and help clinicians treat GBM with precision.
Not only can this tool help clinicians react quickly to early tumor progression with switching therapies, or treat PsP conservatively, but also it helps to relieve the uncertainty and stress for patients and their loved ones.
Reducing “Scanxiety” and a New Outlook
Oxenberg smiles with her grandchildren and 73rd birthday cake that reads, "Happy Birthday Bubby"
“Thank G-d I can see the doctors immediately after my scans,” said Oxenberg. “Hearing my results right away and walking away from an appointment with a game plan lets me enjoy my life between scans.”
Oxenberg has plenty to enjoy: a resident of Elkins Park, Pa., she lives with her husband, Larry, with whom she has two children and four grandchildren. When she’s not spending time with family, she fills her time with Israeli folk dancing, Torah classes, and a writing group. She also raises awareness for brain cancer, and helps educate patients with GBM, like herself, on how to live with the disease. Oxenberg has also raised more than $120,000 for the National Brain Tumor Society. She walks each year in the organization’s Race for Hope and is part of the Pennsylvania race planning committee.
Find more information on GBM treatments, clinical trials, and more, at Penn Medicine’s Brain Tumor Center.