Each year, an estimated 22,000 adults in the United States are diagnosed with primary malignant tumors of the brain. These are tumors that originate in the brain. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. The most common primary brain tumors are gliomas. They begin in glial cells, which are the supportive cells of the brain. Glial cells surround and hold in place the nerve cells, or neurons, which receive and send messages between the body and the brain. In this chapter we talk about gliomas; glioblastomas and glioblastoma multiforme are types of gliomas. Targeted Treatments for Brain Cancer BEVACIZUMAB WITH AND WITHOUT IRINOTECAN FOR RECURRENT GLIOBLASTOMA As with other types of cancer, clinical trials are showing the benefits of targeted treatments for brain cancer. Unlike chemotherapy, targeted treatments attack specific molecules and cell mechanisms thought to be important for cancer cell survival and growth. This specific targeting helps to spare healthy tissues and causes less severe side effects. The results of a recent study offer hope to people with relapsed (return of cancer) glioblastoma multiforme, a common and fast-growing type of brain cancer. More than 150 people with recurrent glioblastoma multiforme took part in this study, which was conducted by researchers at Duke University’s Preston Robert Tisch Brain Tumor Center and at a number of other centers. About half of the people were treated with bevacizumab (Avastin) alone, and the others received a combination of bevacizumab and irinotecan (Camptosar and others). Their recurrent glioblastoma had not responded to initial treatments. Bevacizumab is a targeted treatment that starves tumors of the blood supply they need to survive. It works by blocking the action of vascular endothelial growth factor (VEGF). VEGF is a substance that plays a critical role in the growth of new blood vessels in the body and in the spread of tumors. Because glioblastoma multiforme tumors have high levels of VEGF and depend on a rich blood supply for their growth, bevacizumab was a logical choice for study in this type of brain tumor. In people with relapsed glioblastoma multiforme, bevacizumab appears to work as well alone as it does in combination with the chemotherapy irinotecan. Forty-three percent of the patients in this clinical trial who were treated with bevacizumab alone went six months without their tumors growing. In those treated with bevacizumab plus irinotecan, 50 percent went six months without their tumors growing…

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