John McCain.

July 21, 2017. His Senate office announced on Wednesday that he has been diagnosed with Glioblastoma Multiforme (GBM). GBM is the most common primary malignant brain tumor, with roughly half of cases occurring in older adults. The announcement indicates his surgeons were able to achieve a gross total resection, which is associated with improved survival. GBM generally has a poor prognosis, and older patients unfortunately have an even shorter median survival. Important prognostic factors include the methylation status of the MGMT gene and the mutation status of the IDH-1 & -2 genes. In any case, standard care would include hypofractionated (shorter course) RT concurrent with chemotherapy (temozolomide). Upon completion, continued chemo and tumor treating fields improve survival compared to chemo alone. While tumor vaccines and oncolytic viruses have generated buzz in recent years, phase III data in GBM hasn’t panned out yet. Want more? JCO has a recent special issue on CNS malignancies.


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