Genetic Biomarker Indicates Aggressiveness in Brain Tumors

Recent research has identified a promising genetic biomarker that can help predict the behavior of brain tumors, specifically meningiomas, which are the most common primary brain tumors. Traditionally, clinicians classify meningiomas into three grades based on their microscopic characteristics, growth rate, and invasion potential, ranging from slow-growing to highly aggressive. However, this classification may not always accurately reflect the tumor’s true biological activity.

A multi-institutional study published in The Lancet Oncology highlights the significance of the telomerase reverse transcriptase (TERT) gene activity. The researchers found that tumors exhibiting high TERT expression tend to recur more swiftly, regardless of their grade under microscopic examination. Remarkably, about one-third of the analyzed tumors showed elevated TERT levels without possessing the genetic mutation commonly associated with the gene.

Dr. Gelareh Zadeh from Mayo Clinic emphasized that high TERT expression correlates strongly with quicker disease progression, making it a valuable biomarker for identifying patients at higher risk of aggressive tumor behavior. This discovery is particularly important because TERT activity appears to serve as an early warning sign, signaling more rapid tumor growth and recurrence.

The enzyme telomerase, which maintains chromosome telomeres, is usually inactive in adult cells. When activated in tumor cells, it promotes unchecked growth, fueling cancer development. The study investigated whether TERT expression alone, even without mutations, could predict worse clinical outcomes. The team analyzed over 1,200 meningioma samples from patients in Canada, Germany, and the US, revealing that elevated TERT levels could indicate a tumor’s potential for aggressive growth.

Patients with TERT-positive tumors experienced earlier tumor regrowth compared to those without such activity. Interestingly, TERT expression could make a tumor behave as if it were one grade higher, influencing treatment strategies and monitoring protocols.

These findings suggest that testing for TERT activity could become a routine part of meningioma diagnosis, helping clinicians decide on more personalized and aggressive treatments for high-risk cases. Dr. Chloe Gui, a neurosurgery resident and study lead, noted that integrating TERT testing into clinical workflows could improve outcomes by better tailoring treatments based on the tumor’s biological profile.

This research is part of the Mayo Clinic’s Precure initiative, aiming to develop tools that predict and prevent disease progression by understanding biological processes early on. Moving forward, researchers are exploring how to incorporate TERT activity testing into standard practice, which could reshape the landscape of brain tumor management and improve patient prognosis.