Einat Erlich Diagnosed With Glioblastoma, Highlighting Challenges of Aggressive Brain Tumor

Israeli media personality Einat Erlich revealed last week that she has been diagnosed with glioblastoma (GBM), an aggressive and malignant brain tumor, and has already undergone surgery for its removal. Erlich, known for her focus on health and wellness, shared her emotional journey on Instagram, expressing determination to fight the disease despite fear and sadness. Her diagnosis brings attention to GBM, one of the most difficult brain tumors to treat.

Dr. Ido Feldor, head of neuro-oncology at Shaare Zedek Medical Center, explained that glioblastoma originates in the brain, unlike metastatic tumors. It is the most common primary malignant brain tumor in adults, though still relatively rare, affecting approximately 3 to 5 people per 100,000 annually in Israel, resulting in a few hundred new diagnoses each year. While it can occur in younger individuals, the risk increases with age. Classification has evolved to include molecular and genetic characteristics alongside microscopic appearance, though treatment often remains similar across subtypes.

A significant challenge with GBM is the lack of clear causes. Unlike cancers with identifiable risk factors like smoking or UV exposure, GBM often develops without a discernible trigger. "There are no real risk factors. I always tell patients it's bad luck," Dr. Feldor stated, noting that while rare genetic syndromes can increase risk, lifestyle choices like smoking or diet do not significantly impact it. Significant exposure to ionizing radiation, such as from prior head radiotherapy, is a rare exception. Currently, there is no screening test for GBM in healthy individuals, and research has not established a conclusive link to mobile phone use.

Symptoms vary widely depending on the tumor's location, size, and pressure on surrounding brain tissue. They can include headaches, nausea, blurred vision, weakness in limbs or face, speech difficulties, or sensory disturbances. Seizures can also be an initial symptom. In some cases, GBM is discovered incidentally during imaging scans for other reasons. While CT and MRI scans can suggest a tumor, a definitive diagnosis requires a pathological examination of tumor tissue.

When operable, surgery aims for maximal safe resection to remove as much of the tumor as possible without causing significant neurological damage. This procedure also provides tissue for diagnosis. However, surgery may not be feasible if the tumor is in a critical functional area, is too widespread, or if the patient's overall health poses too high a risk. In such cases, a biopsy may be performed for diagnosis and molecular characterization. Following surgery, the standard treatment involves radiation therapy and chemotherapy, typically with temozolomide, for several months, followed by further temozolomide cycles. A wearable device delivering electric fields is another treatment option that can be combined with standard therapy. If the cancer recurs, treatment options may include further surgery, medication like bevacizumab (Avastin), additional radiation, or clinical trials.

Despite treatment advancements, GBM remains incurable. The tumor's diffuse growth pattern, with cancer cells present in areas appearing normal on MRI, makes complete eradication difficult. The median survival for patients receiving standard treatment is around 1.5 years, though individual prognoses vary significantly based on age, functional status, extent of resection, and tumor characteristics. While rare, some patients do achieve long-term survival, living five, ten, or even more years beyond diagnosis. Research continues to explore new treatments, including immunotherapy, vaccines, and CAR-T cell therapy, with the ultimate goal of transforming GBM into a manageable chronic condition. Dr. Feldor cautioned against unproven "miracle cures" and emphasized the importance of fighting the disease with determination and adherence to evidence-based treatments.