Brighter Horizons and Advances in Neuro-Oncology With Jonathan Sherman, MD, FAANS, FCNS, FACS, and Morana Vojnic, MD, MBA

New Therapies and Approvals

Dr. Vojnic highlighted several significant developments in brain tumor management over the past year. “There are always exciting things happening—not as many as we would like, but it’s still very promising and encouraging,” she noted. Among the most notable advances is the FDA approval of the isocitrate dehydrogenase (IDH) inhibitor vorasidenib for IDH-mutant low-grade gliomas, offering new hope for patients with these challenging tumors.

Pediatric neuro-oncology also saw progress with the approval of tovorafenib, a BRAF inhibitor, for children with recurrent low-grade gliomas harboring BRAF alterations. Additionally, new therapies for NF1-associated plexiform neurofibromas and investigational agents for H3K27M-mutant gliomas are expanding the treatment landscape.

Surgical Innovation: Preserving Function and Quality of Life

Dr. Sherman emphasized the integration of cutting-edge technology in neurosurgical oncology. “One of the biggest things that has come into play is what we call functional balance—how can we maximally resect a tumor while minimizing any deficit or problems for the patient,” he explained. Advances such as mapping the brain’s major networks, using neuropsychological assessments pre- and intra-operatively, and employing fluorescent-guided surgery are helping surgeons achieve more precise resections while preserving critical functions. “We’re integrating augmented and virtual reality for surgical planning, which not only helps us but also empowers patients to better understand their treatment,” Dr. Sherman added.

Expanding Access to Innovations

Because these innovations are most accessible at high-volume academic centers, Dr. Sherman acknowledged the challenges faced by smaller hospitals. “The combination of all these technologies is more readily available in the traditional academic center,” he said, noting that patient volume and resources are key factors. However, as these technologies become more established, the hope is that they will spread to community hospitals, improving access to advanced care for all patients.

Emerging Diagnostics: Liquid Biopsies and Noninvasive Tools

Both clinicians discussed the promise of liquid biopsies—blood-based assays that can detect tumor mutations noninvasively. “In an ideal world, we would be able to decide how to treat patients based on a blood test,” Dr. Vojnic said. While sensitivity remains a challenge due to the brain’s unique environment, these tools are beginning to aid diagnosis and treatment decisions, especially when traditional biopsies are risky.

Looking Ahead: Multimodal and Personalized Care

The future of brain tumor treatment lies in combining multiple therapies to target tumor heterogeneity. “It’s too idealistic to think one drug will shrink the whole tumor. We probably need to use multiple agents at the same time to attack different pathways,” Dr. Vojnic emphasized. Ongoing trials and research are moving the field closer to this goal.

Messages of Hope for Brain Tumor Awareness Month

As Brain Tumor Awareness Month continues, both experts urge clinicians and patients to stay informed and proactive. “Don’t be afraid to ask questions or seek second opinions. There are many people willing to help,” Dr. Vojnic advised. “We are here to really improve our patients’ quality of life and longevity.”

Dr. Sherman echoed this optimism: “We’re really on the cusp. Patients are living longer, and we’re making strides in quality of life and survivorship. We’re looking to see major outcomes in the next few years.”

Key Takeaways

• Recent FDA approvals and investigational agents are expanding treatment options for both adult and pediatric brain tumors
• Surgical advances focus on maximizing tumor removal while preserving neurological function, aided by technologies like brain mapping and virtual reality
• Access to advanced care is greatest at academic centers, but efforts are underway to broaden availability
• Liquid biopsies and noninvasive diagnostics are emerging tools, though challenges remain
• Multimodal, personalized therapy is the future of brain tumor care
• Clinicians and patients should remain hopeful, informed, and engaged in the care journey

About the Speakers

Morana Vojnic, MD, MBA, is the Director of Neuro-Oncology at Rutgers Cancer Institute. She specializes in thoracic and neuro-oncology, with expertise in the treatment of lung cancer, mediastinal tumors, head and neck cancer, brain cancer, and metastatic lesions of the brain and spine. With a background in molecular genetics, Dr. Vojnic designs personalized treatment plans and protocols using targeted drugs, immunotherapy, and chemotherapy for the treatment of patients with these diseases.

Jonathan Sherman, MD, FAANS, FNCS, FACS, is the Chief of Neurosurgical Oncology at Rutgers Cancer Institute and Robert Wood Johnson Barnabas Health. He is also a Professor of Neurosurgery at Rutgers Robert Wood Johnson Medical School. Dr. Sherman specializes in the treatment of brain and spinal tumors, and he is a pioneer in the use of healthcare innovations such as virtual and augmented reality to improve patient outcomes.