1. 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

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

3.  Primary Glioblastoma  Secondary Glioblastoma GBM PATHOGENESIS

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

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

6.  10q  P53  MDM2  PGDF-alpha  PTEN  MAC1-E1, MAGE-E1, NRP/B  P16 and RB MOLECULAR ALTERATIONS Molecular alterations characterized

7.  10q  p53 10Q AND P53 Loss of heterozygosity on Chromosome 10q

8.  EGFR  MDM2 EGFR AND MDM2 EGFR Pathway MDM2 Pathway

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

10.  P16  RB P16 AND RB RB response

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

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

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

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

15.  Surgery  Radiotherapy  Brachytherapy and radiosensitizers SURGERY AND RADIOTHERAPY

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

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

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

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

20.  Univariate Analysis results RESULTS Post-head injuries Median Survival (95% CI)HR (95% CI)P-value Grade Low15.8010.0524.54 1.000 High7.987.039.171.7681.4182.204<.0001 Year Group 1976-20058.977.8910.02 1.000 2006-20117.905.6814.320.9070.7391.1140.3531 Race 0.0525* Black15.879.1725.430.6770.4371.0490.0808 Hispanic16.828.1237.060.6410.4220.9750.0378 Other/Unknown12.672.60 0.7430.3971.3910.3536 White8.187.169.63 1.000 Age <6018.9615.7722.18 1.000 ≥605.164.505.953.0542.5313.685<.0001

21.  Multivariate Analysis results RESULTS HR (95% CI)P-value Grade Low 1.000 High1.5421.2291.9360.0002 Year Group 1976-2005 1.000 2006-20110.7970.6460.9830.0344 Race 0.5029* Black0.7800.5031.2090.2657 Hispanic0.8160.5351.2450.3453 Other/Unknown0.8150.4341.5310.5244 White 1.000 Age <60 1.000 ≥602.8772.3773.482<0.0001

22.  2006 post treatment  High age and grade  Race ANALYSIS AND CONCLUSION

23.  Acknowledgements  Questions? THANK YOU