Brain Tumor Specialist in Dallas
UT Southwestern medical oncologist Elizabeth Maher, M.D., Ph.D., specializes in low-grade gliomas – a family of malignancies that affect the glia, or supportive tissues, of the brain. Though they represent only about one in four of all brain tumors, the majority of gliomas are malignant. About half of gliomas are the late-stage, aggressive malignancies known as glioblastomas.
The Director of UT Southwestern’s translational research program in Neuro-Oncology, Dr. Maher devotes much of her time to research while continuing to provide patient care alongside colleagues in medical oncology, radiation oncology, and neurosurgery.
“We are waging a war against these tumor cells,” Dr. Maher says. “So the questions we ask are, ‘What is in our arsenal, and when will we deploy it?’ Just as in a well-planned military mission, we are going to move in slowly with the right equipment, evaluate the situation carefully, and then act on that information.”
UT Southwestern physician-scientists like Dr. Maher monitor gliomas with leading-edge imaging techniques that precisely identify the biomarkers of each tumor.
“While we’re tracking gliomas, we’re also working on how to kill their cells,” she says. “For example, we’re looking at ways to ‘cut the fuel line’ that provides the metabolic energy these tumors need to survive. You can have a fancy sports car in your driveway, but if the gas tank is empty, it’s not going anywhere.”
Offering Hope Through Research
While the diagnosis of any type of brain cancer is frightening, Dr. Maher has a powerful message for glioma patients: There is hope. Ongoing advances in the biomedical understanding of these tumors are paving the way for highly personalized treatments.
Just as importantly, she emphasizes, there is time – time to obtain a precise diagnosis and develop a customized plan of care for each patient’s specific condition and needs.
“The average survival for patients with low grade (Grade 2) gliomas is about 10 years after diagnosis,” Dr. Maher says. During much of that time, she explains, a patient’s brain scans appear stable because the tumor cells are mostly dormant (not actively replicating).
In addition, certain gliomas have recently been discovered to have a genetic mutation affecting a metabolic enzyme called IDH (isocitrate dehydrogenase), which is associated with a better outcome than non-mutated IDH.
Dr. Maher and her colleagues in the Advanced Research Imaging Center at UT Southwestern have developed a powerful method for detecting 2-hydroxyglutarate (2HG), a chemical produced by IDH-mutant gliomas. The team uses an MRI scan that incorporates 2HG imaging to make the diagnosis of an IDH-mutant glioma, which allows them to give a prognosis and follow the patient’s progress during treatment.
Dr. Maher views the first few years following a low-grade glioma diagnosis as a window of opportunity to create a detailed molecular profile of the tumor, pinpoint the optimum time to begin treatment, and then enroll the patient in the most appropriate clinical trials available at that time.
Pursuing a Positive Prognosis
Dr. Maher notes that a positive attitude is extremely helpful for glioma patients.
“An increasing number of patients will do well, and we don’t want them to waste precious time feeling discouraged, especially when the research is yielding such important new findings.
“There is also a major therapeutic benefit in understanding what you’ve got, believing you will do well, and trusting the team that is treating you,” she says. “Things are changing rapidly, and UT Southwestern is at the forefront of these advances.”
One of Dr. Maher’s patients was diagnosed with glioblastoma nine years ago – a year before the IDH mutation associated with a better prognosis for glioma patients was identified. Recently he was confirmed to have the mutation. “He has gone on with his life and done really well,” she says, “but imagine if I had been able to tell him how good his chances were when he was first diagnosed.”
Another patient, a woman in her late 20s, was devastated upon being diagnosed with glioma while receiving a brain scan following a minor auto accident.
“We determined that she has the IDH mutation and 2HG can be detected by MRI,” says Dr. Maher. “So we talked about how we are going to evaluate and monitor her tumor, then determine the treatment techniques and timing. She is very glad to have a detailed diagnosis, a positive prognosis, a good way to monitor the tumor with imaging, and a clear plan.”
The most important message, Dr. Maher stresses, is that if you or a loved one is diagnosed with glioma, “There is hardly ever a need to rush immediately into treatment. Everyone needs a second opinion and a short- and long-range plan before starting treatment."