What Is Glioblastoma?
Glioblastoma (GBM), also called grade 4 astrocytoma or glioblastoma multiforme (GBM), is the most aggressive primary brain tumor in adults. It arises from astrocytes — the supportive cells of the brain — and is classified as WHO Grade 4, the highest grade of malignancy. GBM accounts for roughly 14% of all brain tumors and approximately 50% of all malignant gliomas.
A diagnosis of glioblastoma is life-changing. If you or someone you love has recently been diagnosed, the most important first step is connecting with a fellowship-trained neuro-oncologist who specializes in GBM management — not a general neurologist or community oncologist.
For Southwest Virginia patients: You do not need to travel to Charlotte, Richmond, or Washington D.C. for specialized GBM care. Dr. Mohammed brings MD Anderson–level neuro-oncology expertise directly to Carilion Clinic in Roanoke.
Key Molecular Markers in GBM
Modern glioblastoma care is guided by molecular profiling of the tumor. Understanding your tumor's biomarkers determines treatment selection, clinical trial eligibility, and prognosis. Dr. Mohammed interprets these results as part of every new GBM evaluation.
Standard GBM Treatment (Stupp Protocol)
The standard-of-care for newly diagnosed glioblastoma follows the Stupp protocol, which combines maximal safe surgical resection with concurrent chemoradiation followed by adjuvant chemotherapy. Dr. Mohammed coordinates this multidisciplinary care and manages the medical oncology component.
Surgery to remove as much tumor as possible while preserving neurological function. Gross total resection, when achievable, is associated with improved outcomes.
Radiation therapy (60 Gy in 30 fractions) delivered simultaneously with daily temozolomide (TMZ) chemotherapy over approximately 6 weeks.
Following chemoradiation, patients receive 6 cycles of adjuvant TMZ (150–200 mg/m² for 5 days every 28 days). Benefit is most pronounced in MGMT-methylated tumors.
FDA-approved TTFields (Optune device) added to adjuvant TMZ has demonstrated improved overall survival in the EF-14 trial. Dr. Mohammed incorporates TTFields into eligible patients' treatment plans.
Regular MRI brain with and without contrast, assessed using RANO criteria to distinguish true tumor progression from pseudoprogression — a critical distinction that affects treatment decisions.
Recurrent Glioblastoma
Unfortunately, glioblastoma recurs in the majority of patients. Recurrence does not mean that treatment options are exhausted. Dr. Mohammed is experienced in evaluating and managing recurrent GBM, and approaches each recurrence with an individualized plan.
Options at Recurrence May Include:
Bevacizumab (Avastin) — An anti-angiogenic agent that is FDA-approved for recurrent GBM. Often used to control tumor-related edema and delay progression, and can significantly improve quality of life.
Re-resection — Selected patients with accessible recurrent tumor may benefit from repeat surgical resection, particularly when functional status is preserved.
Re-irradiation — Stereotactic radiosurgery (SRS) or fractionated re-irradiation may be options in carefully selected patients at recurrence.
Clinical Trial Enrollment — Dr. Mohammed is actively building clinical trial infrastructure at Carilion Clinic to give Southwest Virginia GBM patients access to investigational therapies without requiring travel to major cancer centers.
Lomustine (CCNU) or other chemotherapy — Second-line cytotoxic agents for patients with adequate bone marrow reserve and performance status.
Second opinions are welcome. If you have already been seen elsewhere and want a fresh perspective on your treatment plan, Dr. Mohammed is available for neuro-oncology second opinions for GBM patients throughout Virginia and surrounding states.
Why GBM Care Requires a Specialist
Glioblastoma management is among the most complex in all of oncology. Optimal care requires expertise in tumor molecular profiling, RANO-based MRI interpretation (including distinguishing pseudoprogression from true progression), temozolomide toxicity monitoring, TTFields management, clinical trial eligibility assessment, and the evolving landscape of targeted and immunotherapy trials.
A general neurologist or community oncologist may not have the subspecialty training required to manage these nuances. Dr. Mohammed's fellowship at MD Anderson — the world's leading cancer center — was specifically focused on neuro-oncology, and his research includes more than 40 peer-reviewed publications in brain tumor treatment.