For Glioma Patients, Realism Meets Hope in Search for Better Therapies
- When someone is told they have a glioma, the conversation between doctors, patients, and loved ones is often difficult — but balancing hope with realism is a key part of cancer care.
- A recent article published in The Lancet showed that overall, cancer care has been falling short in meeting the emotional needs of patients.
- “We sometimes go through this battle of wanting to provide optimism and, at the same time, wanting to be realistic with the patients and the families,” Dr. Timothy Cloughesy, a neuro-oncologist at UCLA, told SurvivorNet during the Society for NeuroOncology (SNO) Annual Meeting 2025. “This kind of dichotomy of our roles can create some tension with the patients and with the caregivers and maybe even create an existential crisis.”
- Realistic optimism might sound like this: “We may not be able to cure this, but we can treat it, manage your symptoms, and support you along the way.”
When someone is told they have a glioma, the reactions from the patient and their loved ones can really run the gamut — but it’s always a difficult conversation in one way or the other. And it’s likely that more of those difficult discussions will follow. Doctors are expected to be honest and hopeful at the same time, and that’s not easy.
It’s something that needs to be addressed, though.
In 2023, there were 18.5 million new cancer diagnoses globally and 10.4 million deaths, according to a major international analysis published in The Lancet. The same report projects that cancer deaths could rise by more than 70% by 2050.Those numbers are overwhelming. And while that report wasn’t only about brain tumors, it shapes the reality that every glioma patient and every brain tumor specialist is living inside.
“We sometimes go through this battle of wanting to provide optimism and, at the same time, wanting to be realistic with the patients and the families,” Dr. Timothy Cloughesy, a neuro-oncologist at UCLA, told SurvivorNet during the Society for NeuroOncology (SNO) Annual Meeting 2025.
“This kind of dichotomy of our roles can create some tension with the patients and with the caregivers and maybe even create an existential crisis.”
So, how can doctors be realistic in a way that supports their patients’ needs?
What ‘Realism’ Means in Glioma Care
Realism doesn’t mean being cold. It means refusing to lie.
“You need to be confident in what you’re sharing with the patients. It’s okay to give them good prognostic information, and it’s also okay to give them bad prognostic information,” Dr. Katherine Peters, neuro-oncologist at Duke Cancer Center Brain Tumor Clinic, told SurvivorNet during the conference.
Realism might mean explaining difficult things like:
- This is a serious disease
- Surgery cannot always remove every cell
- Some tumors grow back even after treatment
Good doctors don’t sugarcoat that because patients deserve the truth. But realism should never feel like abandonment.
”Life with a brain tumor is really, really hard. My patients are the best, and I am very happy every day to go to the clinic to work. I know it’s going to be tough, but I want to be there for them in that tough space,” Dr. Peters added.
Personalized Care For Patients
Hope is not the same thing as pretending — and providing it for patients can be an important part of good cancer care. A recent article published in The Lancet showed that overall, cancer care has been falling short on meeting the emotional needs of patients.
Realistic optimism might sound like this: “We may not be able to cure this, but we can treat it, manage your symptoms, and support you along the way.” That kind of hope is grounded in reality.
There are real reasons doctors can be cautiously optimistic — for many types of cancer, treatment options have come a long way in recent years.
“It’s really exciting that we have a smart therapy now, that isn’t just a traditional chemotherapy, something that can actually target the tumors themselves,” Dr. Peters said of glioma and the specific patterns that can be treated with targeted therapy.
A new targeted drug called vorasidenib (brand name Voranigo) is changing the landscape of treatment for some patients with low-grade glioma, offering a potentially game-changing approach to managing the disease. Currently, it’s approved for grade 2 glioma, but there is some research looking into expanding that use.
“I tell all my residents it’s really an exciting time to be a neuro-oncologist. We have had so many new FDA-approved therapies in the past year and a half. I couldn’t have said that five years ago,” Dr. Kathryn Nevel, neuro-oncologist at Indiana University, told SurvivorNet.
The Promise Of Vorasidenib
Vorasidenib is an oral medication designed specifically to target low-grade gliomas that have mutations in the IDH1 or IDH2 genes. These mutations are found in the majority of low-grade gliomas and are thought to drive tumor growth by disrupting normal cellular metabolism.
Unlike traditional chemotherapy or radiation therapy, which can have significant side effects, vorasidenib is a targeted therapy — meaning it directly interferes with the cancer’s ability to grow while sparing healthy cells as much as possible. This makes it an attractive option for patients looking for an effective yet less toxic treatment.
Normally, IDH enzymes help cells carry out essential metabolic processes. However, when these enzymes are mutated, they produce an abnormal substance called 2-hydroxyglutarate (2-HG), which prevents cells from differentiating properly. This leads to uncontrolled tumor growth.
Vorasidenib works by blocking the activity of mutant IDH enzymes, reducing the levels of 2-HG. As a result, the abnormal tumor cells slow their growth and may even revert to a more normal state. This delay in tumor progression allows patients to postpone or avoid more aggressive treatments.
When Is Vorasidenib Recommended?
“This is a discussion that happens pretty often when we’re talking about patients and who’s appropriate for Vorasidenib therapy upfront versus who maybe we should be leaning more towards chemotherapy and radiation after initial diagnosis,” said Dr. Nevel.
Vorasidenib is indicated for patients with IDH1 or IDH2-mutant low-grade gliomas that are not rapidly progressing. It is particularly beneficial for those who have been diagnosed with the disease but do not yet require immediate invasive treatment such as radiation or surgery.
In many cases, patients with low-grade gliomas adopt a “watch and wait” approach, where doctors monitor the tumor with regular MRIs.
Vorasidenib offers an alternative to simply waiting, as it actively slows tumor growth and may extend the period before more aggressive treatment is necessary.
