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Recent scientific advancements are starting to transform the difficult landscape of brain cancer diagnoses. For decades, brain cancer, particularly gliomas, has been among the most challenging prognoses in medicine.
Gliomas, including the particularly aggressive form known as glioblastoma, have long resisted effective treatments. Despite intensive therapies, glioblastoma typically results in an average survival of only 15 months. However, these new advancements are beginning to offer hope by reshaping this previously dire prognosis.
The complexity of the brain, coupled with the protective yet obstructive blood-brain barrier, has historically impeded treatment efforts. This barrier, essential for shielding the brain from toxins, also prevents many drugs and immune cells from reaching cancerous regions. Consequently, survival rates for brain cancer have remained stagnant for decades, even as other cancers have seen significant advancements.
As Singapore grapples with an ageing population, the prevalence of brain cancer is expected to rise significantly over the next two decades. This growing burden underscores the urgency of advancements in treatment.
Researchers are making strides in several other areas. Novel biomarkers are being identified for earlier detection, and new diagnostic tools are being developed to better understand glioblastoma subtypes. Advances in understanding the tumours’ micro-environment are revealing key metabolic and immunological pathways crucial for their survival.
In Singapore, local researchers are contributing significantly to these global efforts. At the National University of Singapore’s Yong Loo Lin School of Medicine, Associate Professor Too Heng-Phon is pioneering stem cell-based gene therapies that not only target cancer cells but also enhance the patient’s immune response. Human clinical trials for this therapy are anticipated to begin in 2025, offering new hope for patients with recurrent glioblastoma.
A major challenge in brain cancer treatment is developing therapies that can cross the blood-brain barrier. Addressing this, Dr Andrea Pavesi at A*STAR’s Institute of Molecular and Cell Biology (IMCB) has developed a cutting-edge microfluidic device that simulates the barrier and brain tumours. This device allows for rapid screening of new chemotherapeutic drugs and evaluates their efficacy in crossing the barrier, a crucial step in developing more effective treatments.
Additionally, IMCB’s Neuro-Phenomics Laboratory is focusing on three critical areas: identifying novel biomarkers for early detection, creating drugs capable of crossing the blood-brain barrier, and understanding the tumours’ micro-environment. This research aims to enhance the body’s natural immune response to glioblastoma, moving beyond traditional approaches that focus solely on intrinsic cancer mechanisms.
Personalised medicine approaches are also being explored, tailoring treatments to the individual profiles of patients. By analysing unique tumour characteristics, these strategies aim to create more effective and less toxic treatment options.
Other breakthroughs are offering new hope. In 2009, research identified mutations in the isocitrate dehydrogenase (IDH) 1 and 2 genes as critical drivers of certain brain tumours. This discovery has led to significant progress, including the recent FDA approval of vorasidenib, the first new treatment for low-grade gliomas in over 20 years. This drug targets mutated IDH genes, slowing tumour growth and delaying the need for more toxic treatments like radiation and chemotherapy.
As the global population ages, the urgency of addressing brain cancer grows. With surgery alone unable to completely eradicate brain tumours, the future of curing brain cancer, particularly glioblastoma, lies in the laboratory. Ongoing research is inching closer to transforming brain cancer from a dire prognosis into a manageable condition.
Singapore’s vibrant clinical research ecosystem, advanced infrastructure, and substantial funding position it as a leader in the fight against glioblastoma in Asia. As research continues, each breakthrough brings us closer to a future where brain cancer is no longer a death sentence, offering hope to patients and their families worldwide.
