The first 60 days: Brain and spinal cord tumours (all types)

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• SurgeonNamed in the standard of care for: Glioblastoma, IDH-mutant low-grade glioma, Childhood tumours.
• Medical oncologistNamed in the standard of care for: Glioblastoma, IDH-mutant low-grade glioma, Childhood tumours.
• Clinical oncologist (radiotherapy)Named in the standard of care for: Glioblastoma, IDH-mutant low-grade glioma, Childhood tumours.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Glioblastoma

   Maximal safe resection, radiotherapy with concurrent and adjuvant temozolomide (Stupp regimen), tumour-treating fields as an option. See the glioblastoma page.

   Temozolomide
2. 2.IDH-mutant low-grade glioma

   Surgery, then observation or vorasidenib for grade 2 tumours, radiotherapy and chemotherapy for higher risk.

   Vorasidenib
3. 3.Childhood tumours

   Risk-adapted surgery, radiotherapy and chemotherapy by subgroup; BRAF and MEK inhibitors for BRAF-altered low-grade glioma. See the medulloblastoma, ependymoma and DIPG pages.

   DabrafenibTrametinib

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Prospective Pivotal Study to Evaluate the Efficacy and Safety of Avastin® Bevacizumab (BEV) With or Without Microbubble-mediated Focused Ultrasound (FUS-MB) Using NaviFUS System in Recurrent Glioblastoma Multiforme PatientsPhase 3 · recruiting · NCT06496971A Prospective, Randomized, Standard of Care Controlled, Parallel, Open-Label, Multicenter Pivotal Study to Evaluate the Efficacy and Safety of Avastin® in Combination With NaviFUS System Compared With Avastin® Alone for the Treatment of Recurrent Glioblastoma Multiforme (rGBM)
• Post-Surgical Stereotactic Radiotherapy (SRT) Versus GammaTile-ROADS (Radiation One and Done Study)Phase 3 · active · NCT04365374A Phase 3 Randomized Controlled Trial of Post-Surgical Stereotactic Radiotherapy (SRT) Versus Surgically Targeted Radiation Therapy (STaRT) With Gamma Tile for Treatment of Newly Diagnosed Metastatic Brain Tumors.
• GBM AGILEPlatform trial · recruiting · NCT03970447Newly diagnosed glioblastoma (MGMT methylated and unmethylated) and recurrent glioblastoma: a Bayesian adaptive platform that screens experimental drugs against a shared standard-of-care control on overall survival and lets a winning arm expand seamlessly into a confirmatory stage
• A Pivotal Phase II Clinical Trial of Utidelone Injection Plus Capecitabine in HER2-negative Breast Cancer Patients With Brain MetastasesPhase 2 · recruiting · NCT06764940A Pivotal Phase II Clinical Trial of Utidelone Injection (UTD1) Plus Capecitabine (CAP) in HER2-negative Breast Cancer Patients With Brain Metastases
• A Study to Evaluate Tabelecleucel in Participants With Epstein Barr Virus (EBV) Associated DiseasesPhase 2 · active · NCT04554914An Open-label, Single-arm, Multicohort, Phase 2 Study to Assess the Efficacy and Safety of Tabelecleucel in Subjects With Epstein Barr Virus Associated Diseases (EBVision)

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Brain and spinal cord tumours (all types): the full pageBrain and spinal cord tumours range from slow-growing meningiomas and low-grade gliomas to glioblastoma, the commonest malignant brain tumour in adults, and a distinct set of childhood tumours such as medulloblastoma and diffuse midline glioma. Molecular markers now define them, and treatment is surgery, radiotherapy and, for some, drugs chosen by those markers.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.