Standard of Care "Plus" for Glioma Patients

  • “Standard of Care Plus” uses established therapies like surgery, radiation, and chemotherapy as a foundation while incorporating additional interventions tailored to individual patient needs.
  • Additional therapies may include medications, anti-depressants, or anti-analgesics for symptom relief. Clinical trials also offer innovative treatments.
  • Advanced molecular profiling identifies actionable mutations and guides targeted therapies.
  • Integrative medicine and wellness practices address mental health, quality of life, and symptom management.
  • Providers are encouraged to use the standard of care as a scaffold, incorporate molecular testing, offer clinical trial enrollment, address non-medical needs through supportive care, and tailor treatments to each patient’s unique situation.

The standard of care when managing glioma patients is well established, with a magnitude of clinical evidence leading providers to the best outcomes for their patients. However, many healthcare providers recognize the potential to go beyond this by integrating additional therapies and approaches to address each patient’s unique needs. This is known as “Standard of Care Plus.”

This approach incorporates traditional therapies and explores supplemental options that might optimize quality of life and enhance treatment efficacy.

During a recent panel at SNO 2024, SurvivorNet Connect sat down with top experts in the field to discuss when they might consider adding additional therapies into glioma care.

Building on the Standard of Care

Dr. Katie Peters, a neuro-oncologist at Duke Health, describes “Standard of Care Plus” as “using the standard of care as a scaffold” while thoughtfully integrating additional options tailored to the patient. For some patients, standard therapies like surgery, radiation, and chemotherapy may be sufficient. However, others may benefit from therapies that go beyond this framework.

Ultimately, the decision to incorporate additional treatment measures depends on the patient’s clinical profile and individual preferences.

Expanding Therapeutic Options for Patients

Dr. Alexandra Miller, a neuro-oncologist at NYU Langone Health, emphasized the flexibility of the “Standard of Care Plus” approach. In her practice, she has integrated medications like fluoxetine (Prozac) based on preclinical evidence suggesting potential tumor-directed benefits. Beyond this, medications such as gabapentin may be added to manage symptoms like headaches or improve sleep, with the overarching goal of enhancing patients’ quality of life.

Clinical trials can also play a role in expanding therapeutic options. Dr. Ganesh Rao, a neurosurgeon at Baylor College of Medicine, highlighted the availability of experimental approaches, including oncolytic virus therapies and CAR T-cell treatments, delivered intracavitary during surgery.

These cutting-edge interventions may not yet be part of the standard of care but represent promising opportunities for patients who are candidates.

Molecular and Integrative Advances

The “Standard of Care Plus” framework often incorporates advanced molecular profiling. Dr. Rao noted that testing for rare mutations, such as the BRAF mutation, can identify actionable targets even in gliomas with uncommon alterations. Access to resources like next-generation sequencing (NGS) opens pathways to targeted therapies, providing additional hope for patients who may not respond to standard treatments.

Dr. Erin Dunbar, a neuro-oncologist at Piedmont Healthcare, expanded on this idea, explaining that “Standard of Care Plus” also encompasses non-medical interventions. Integrative medicine involves mind-body wellness practices and reminds us that robust social support systems are essential components. “We aim to help patients live better and longer,” Dr. Dunbar said, emphasizing the value of addressing physical symptoms and broader quality-of-life concerns.

Overcoming Barriers

While the potential benefits of “Standard of Care Plus” are clear, providers often face challenges when implementing these strategies. Access to certain social and supportive services, as well as advanced diagnostics and experimental therapies, may be limited in smaller centers.

However, Dr. Rao and Dr. Peters both noted that partnerships with academic institutions and commercial companies are making these options increasingly accessible. Some companies and services can assist patients by covering the cost of molecular testing when insurance is unavailable, reducing barriers to care.

Recommendations for Providers

  • Standard of Care Comes First: Start with proven therapies and assess each patient’s individual needs to determine where additional interventions may provide value.
  • Incorporate Molecular Testing: Leverage advanced diagnostics to identify actionable mutations and guide personalized treatments.
  • Consider Symptom-Driven Additions: Integrate therapies or medications to address specific symptoms and enhance patient comfort.
  • Utilize Clinical Trials: Offer experimental treatments for eligible patients through trial enrollment.
  • Address Non-Medical Needs: Explore integrative and supportive care options, including mental health support and wellness programs, to improve the overall quality of life for patients.

The “Standard of Care Plus” approach reflects a commitment to going beyond traditional therapies to provide glioma patients with more personalized, comprehensive care. By integrating innovative treatments, advanced diagnostics, and supportive care strategies, providers can address each patient’s unique needs.