Diffuse midline glioma (DMG), is a very aggressive brain tumor that spreads very quickly. There isn't a cure for DMG, but treatments can help manage symptoms so that people with DMG can live longer and more comfortably.
Radiation therapy
The most common treatment for DMG is radiation therapy. Radiation therapy uses precise, highly concentrated beams of energy to destroy the tumor cells. This treatment usually is given in multiple sessions over about six weeks. It can slow down the growth of the tumor and help reduce some of the symptoms it causes.
Unfortunately, DMG tumors often grow back after radiation therapy.
Surgery
Usually, surgery isn't an option for these types of tumors because of where they grow in the brain. They grow in the midline, where essential parts of the brain are found. For this reason, surgery can be too risky. Also, the poorly defined edges of the tumor make it difficult to remove with surgery.
Medicines
Chemotherapy, which is medicine designed to kill cancer cells, usually isn't effective for DMG. But sometimes, chemotherapy may be used along with radiation therapy.
Palliative treatment
Palliative treatment does not aim to cure cancer but to make life better and manage symptoms such as difficulty swallowing, pain, headaches, and difficulty walking and moving around. Palliative treatment for DMG can include:
- Steroid medicines to reduce swelling in the brain.
- Support for feeding and nutrition.
- Speech therapy.
- Occupational therapy.
- Physical therapy.
- Medicines to prevent seizures.
- Pain medicine.
- Procedures to drain fluid buildup on the brain.
- Counseling and other therapy to help cope with DMG.
Potential future treatments
Researchers are studying new medicines to treat diffuse midline glioma and new ways of delivering them. Research includes new chemotherapy medicines that target the changed genes in DMG tumors.
Clinical trials are studying medicines that target these cancer cells specifically and deliver them directly to the tumor via a catheter and other novel methods.
Clinical trials also are looking at immunotherapy treatments for DMG. Immunotherapy medicines help the body's immune system find and destroy cancer cells. These medicines include immune checkpoint inhibitors, monoclonal antibodies and vaccines. All of these treatments target cancer cells through the immune system.
Current clinical trials are investigating the use of chimeric antigen receptor (CAR)-T cell therapy. In this treatment, white blood cells called T cells are removed from the blood. In a lab, scientists change these T cells and add a receptor called a CAR. The CAR allows the T cells to track and find cancer cells more easily.
Scientists then grow and multiply the CAR-T cells in a lab, producing millions of very powerful cells. These CAR-T cells are put back into the blood through a needle placed in a vein in the arm, also called an IV. CAR T-cells can keep living and working in the body for a long time, so they're sometimes called a "living drug."
Prognosis
Every person with DMG and every diagnosis is different. DMG is usually fatal. Life expectancy is usually between 9 and 12 months after diagnosis. Most people survive less than a year after diagnosis. Some people live longer with DMG. This depends on several factors, including how well they respond to treatment and the tumor grade at diagnosis. Clinical trials can help people with DMG live longer.
A healthcare team can provide support and guidance for end-of-life care.