B Y : J AHNAVI U DAIKUMAR D IRECTOR : D R. R ICHARD S ANKER, P H D R ETROSPECTIVE A NALYSIS ON D IFFERENTIAL E FFECTS OF T REATMENT S TRATEGY ON O UTCOME AND S URVIVAL ON M ALIGNANT G LIOBLASTOMA M ULTIFORME P ATIENTS

 Etymology  glia, blastos, oma  1926 Percival Bailey and Harvey Cushing  Basic tumor characterization  Grades  GBM nature WHAT IS GLIOBLASTOMA?

 Primary Glioblastoma  Secondary Glioblastoma GBM PATHOGENESIS

 Genetic mutations  Cell phone usage  Post-head injury  Occupational hazards  Electromagnetic field exposure  Race and Gender  Lifestyle habits ETIOLOGY Post-head injuries

 Viral entrance and immunosuppression  External risk factors  Lead into molecular alterations ETIOLOGY Malaria viral entrance and GBM relationship

 10q  P53  MDM2  PGDF-alpha  PTEN  MAC1-E1, MAGE-E1, NRP/B  P16 and RB MOLECULAR ALTERATIONS Molecular alterations characterized

 10q  p53 10Q AND P53 Loss of heterozygosity on Chromosome 10q

 EGFR  MDM2 EGFR AND MDM2 EGFR Pathway MDM2 Pathway

 PGDF-alpha  PTEN  MAC1-E1  MAGE-E1  NRP/B PGDF-ALPHA, PTEN, MAC1-E1, MAGE-E1, NRP/B PGDF-alpha pathway PTEN pathway

 P16  RB P16 AND RB RB response

 Transcription factor Hes3  IDH1 gene and mutations  Metabolism  Ion channel upregulation STEM-LIKE CELL, METABOLISM AND ION CHANNEL PROBLEMS IDH1 gene mutant

 MRI and CT  MR spectroscopy and perfusion MRI  Biomarkers  Ex: IDH1 gene mutations DIAGNOSIS GBM MRI

 Signs and Symptoms  Vomiting, headaches, memory loss, neurological deficits, hemiparesis  Prevalence  North America and Europe  Gender and age SIGNS, SYMPTOMS, AND PREVALENCE

 Surgery, Radiotherapy, Chemotherapy  Patients over 70 years of age and MGMT methylation  Phase III trial results TREATMENT

 Surgery  Radiotherapy  Brachytherapy and radiosensitizers SURGERY AND RADIOTHERAPY

 Carmustine (BCNU)  Cis-Platinum  Temozolomide  Nitrosoureas and Gliadel wafers CHEMOTHERAPY

 Gene therapy  MGMT methylation and promoter  Problems and progression  Bevacizumab  Tyrosine kinase inhibitors OTHER TREATMENTS

 Patient survival depends on certain factors  Results of study  Further GBM management approaches PROGNOSIS

 Purpose of the Glioma study  Methodology  IRB  HIPPA  Variables of interest PURPOSE AND METHODOLOGY

 Univariate Analysis results RESULTS Post-head injuries Median Survival (95% CI)HR (95% CI)P-value Grade Low High <.0001 Year Group Race * Black Hispanic Other/Unknown White Age < ≥ <.0001

 Multivariate Analysis results RESULTS HR (95% CI)P-value Grade Low High Year Group Race * Black Hispanic Other/Unknown White Age < ≥ <0.0001

 2006 post treatment  High age and grade  Race ANALYSIS AND CONCLUSION

 Acknowledgements  Questions? THANK YOU