MISSION

The Brain Tumour Group initiates and conducts research to challenge, re-define and develop standards of care in controversial areas of diagnostic and therapeutic neuro-oncology. The Group is especially focused on diffuse gliomas of adulthood of World Health Organisation grades II to IV and, in recent years, also meningioma.

PRACTICE CHANGING RESEARCH

Brain cancer: a rare and deadly type of cancer

Brain cancer accounts for about three percent of global cancer cases1.

Approximately fewer than one out of five individuals with brain cancer survive for five years or more after diagnosis.

Brain tumours include various cancer types. Primary brain tumours originate in brain tissue3.

Despite decades of research, brain tumours remain one of the deadliest cancers. Their resistance to most treatments is partly due to the unique properties of neural tissues.

EORTC Brain Tumour Group: setting the standards of treatment

The EORTC Brain Tumour Group researches adult brain tumours, aiming to enhance glioblastoma patient treatments and outcomes. They have established standard therapies, including neurosurgery, radiotherapy, and chemotherapy, through their clinical trials. Ongoing trials test novel approaches such as investigational agents and combined treatment methods.

1 Ferlay, J. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136, E359-86 (2015).
2 Ohgaki, H. Epidemiology of Brain Tumors. Methods in Molecular Biology 472, 323–342 (2009).
3 Aldape, K. et al. Challenges to curing primary brain tumours. Nat Rev Clin Oncol 16, 509 (2019).

Understanding Glioblastoma: a deadly brain cancer

Glioblastoma, a deadly brain cancer, affects all ages. Classified as grade 4 (the most serious and aggressive type of tumour) by the World Health Organisation, they represent, along with grade 3 gliomas, the majority of brain tumours 5. The glioblastoma incidence rate is one in 10,000 of all cancers6. Glioblastomas represent 16% of all primary brain tumours and are usually fatal. Few patients survive following their diagnosis (only one percent survive for ten years or more)7 8.

A game-changing trial: EORTC’s impact on glioblastoma patient survival

This EORTC trial was instrumental to the prolonged survival of glioblastoma patients and remains the standard of care to date. Prior to this trial, the only available treatment was surgery to remove the tumour, followed by radiotherapy to the brain. That treatment, however, had very little impact on patients’ survival. The EORTC trial successfully showed that a drug called temozolomide allowed many patients to live longer when taken as a pill after surgery and in addition to radiotherapy. Taking this pill did not cause too many adverse effects for patients, who reported that on average, their quality of life was no worse than that reported by the patients who were not taking the drug.

Paving the way for personalised treatments: identifying the first predictive marker for brain cancer

Since a large number of patients taking this drug saw an improvement, researchers tried to identify ways in which they could predict which patients would benefit (live longer) from this treatment and which would have less chance of doing so. They succeeded in identifying a gene as the first predictive marker in brain tumours (methylation of the MGMT promoter) associated with a better response to the treatment.  To date, this molecular test is used in all patients with glioblastoma and was the one that introduced the concept of personalised treatment in neuro-oncology. This personalised combination treatment has become the standard of care for newly diagnosed glioblastoma patients worldwide.

Study coordinator: Prof. Roger Stupp

4 Gorlia, T. et al. Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 9, 29–38 (2008).
5 Zhang, C., Bao, Z., Zhang, W. & Jiang, T. Progress on molecular biomarkers and classification of malignant gliomas. Front Med 7, 150–156 (2013).
6 Zong, H., Verhaak, R. G. W. & Canolk, P. The cellular origin for malignant glioma and prospects for clinical advancements. Expert Rev Mol Diagn 12, 383 (2012).
7 Chaurasia, A., Park, S. H., Seo, J. W. & Park, C. K. Immunohistochemical Analysis of ATRX, IDH1 and p53 in Glioblastoma and Their Correlations with Patient Survival. J Korean Med Sci 31, 1208–1214 (2016).
8 Jovčevska, I. & Jovčevska, I. Genetic secrets of long-term glioblastoma survivors. Biomolecules and Biomedicine 19, 116–124 (2019).

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PUBLICATION

Rare & Challenging: Understanding Anaplastic Gliomas

Anaplastic gliomas are rare brain tumours, with an incidence of just one in 100,000 people annually. In 70-80% of cases, patients carry a gene alteration called the IDH gene. When the trial was designed, temozolomide (TMZ) was shown to improve survival in grade 4 glioma patients, but not in grade 3 glioma patients with the IDH gene mutation.

Unlocking hope: doubling survival rates for anaplastic glioma patients

The CATNON trial successfully showed that when grade 3 patients are given a combination treatment in a specific order– radiotherapy first, followed by administration of the drug temozolomide – their survival rate doubles. This has been an important study in the field of brain tumour providing a significant increase in the survival of patients with anaplastic gliomas to date.

Study coordinator: Prof. Martin J. van den Bent

9 van den Bent, M. J. et al. Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053-22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 22, 813–823 (2021).

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