Inovative brain cancer treatments at Duke Brain Tumour Center

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This treatment center appears to achieve much longer survival
http://www.dukehealth.org/articles/multipage_article_20031105160651415

Brain Power

The year he turned 36, David Bailey was given up for dead. After suffering a massive seizure, he awoke in the hospital to learn that a baseball-sized tumor had been growing inside his skull: glioblastoma, the most aggressive and deadly form of brain cancer. Though surgeons had removed it, the prognosis was bleak: just six more months of life.
But Bailey wanted to see his young son and daughter grow up, and he was willing to do whatever it took. He went online to search for answers--and ended up at Duke's Brain Tumor Center. There, he was given an experimental antibody therapy, designed to launch tumor-killing radioactive isotopes directly into his remaining tumor cells.
That was in 1997. Today, David Bailey is possibly the best-known brain cancer survivor in America. An accomplished musician who swathes his bald head in brilliantly patterned bandanas, he crisscrosses the country singing his story of survival and hope to thousands of people a year. In April 2002, Bailey, along with two fellow Duke patients, was introduced to an even larger audience: the 27 million people who watched a rare double-length segment on 60 Minutes about the Duke Brain Tumor Center.
As the program showed, the center and its leaders are very much like Bailey: unwilling to accept defeat and--given the odds they face--surprisingly successful. Duke takes an aggressive approach to treating brain cancers, rapidly applying novel treatments and this-just-in research findings to save patients. It's hard to argue with the results of this unusually rapid bench-to-bedside pace. The vast majority of people with glioblastoma die within a year, yet 10 to 15 percent of Duke patients make it past the three-year mark alive--and a number, like Bailey, remain cancer-free substantially longer.
"Most physicians believe that patients with many kinds of brain tumors are so hopeless as to offer them nothing," co-director Henry Friedman, MD, told 60 Minutes correspondent Ed Bradley. The Duke team refuses to accept such fatalism. "We don't just label patients with a prognosis and accept standard therapy," says co-director Allan Friedman, MD, a neurosurgeon (the two are not related). "We keep trying." Sixty-six percent of Duke brain tumor patients participate in clinical trials, compared to just 8 percent nationwide. And the center's aggressive use of experimental drugs, immunotherapy, radiation, and surgery is resulting in unprecedented clinical success.
"We’re seeing long-term survival--three, four, five or more years--in patients who were previously written off," Henry Friedman says. And in brain tumor care as in other endeavors, nothing succeeds like success. By offering the latest treatments, the center attracts more patients--and by attracting more patients, it can conduct more clinical trials of the latest treatments.
"We're able translate our laboratory research into our clinical program very rapidly, because we can seamlessly go from the lab to the clinic," Henry Friedman says. What's more, he and his colleagues are also able to persuade the companies to also support trials in children, a far less lucrative market.
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Within the Cancer Center's laboratories, even newer strategies are being explored. Some Cancer Center researchers are using sophisticated gene analysis techniques to discover which ones are switched on in various brain tumors. Others are genetically manipulating human brain cells to recreate the genetic malfunctions that lead to brain cancers--and discover the weak spots in the cancers' defenses.
Among the most promising therapies to emerge in the past decade are molecular "guided missiles" called monoclonal antibodies that target only the proteins produced by tumors--the type of therapy received by David Bailey. Cancer vaccines use the patient's own immune system to fight cancer, extracting the patient's own immune cells and loading them with brain-tumor proteins that, when reinjected into the body, trigger the immune system to attack the cancer cells. Other novel approaches include techniques designed to thwart the ability of brain cancers to become immune to chemotherapeutic agents, and innovative drug delivery systems that seem to enhance the effectiveness of anti-cancer drugs while reducing their impact on healthy cells.
More often than not, the first-strike attack on a brain tumor is still surgery. "For malignant gliomas, we find that the patients who do best are those who can have more than 90 percent of the tumor surgically removed," says Allan Friedman. "Surgery gives chemotherapy, radiation therapy, and immunotherapy the best chance of doing their jobs and cleaning up remaining tumor cells at the end."
Fortunately, says Allan Friedman, surgery has become simultaneously safer and more aggressive, thanks to such techniques as keeping the patient awake and testing brain function as the tumor is removed. "With awake surgery we can map out important areas of the brain that need to be saved and yet be very radical in our excision," he says. Also improving operating-room outcomes are three-dimensional MRI brain scans, which surgeons use to locate deep tumors.
While it's clear that there is still much work yet to be done, "Where we are compared to 10 years ago is absolutely amazing," says Darell Bigner, MD, PhD, vice chair for investigative pathology at Duke and deputy director of Duke Comprehensive Cancer Center. "Over the next five to 10 years, I think we're going to see quantum leaps in the effectiveness of treatments. And because new therapies target the tumor and not healthy brain tissue, patients will be able to anticipate not only longer survival, but a better quality of life."
Meanwhile, the Duke Brain Tumor Center keeps working around the clock on behalf of brain tumor patients. The center's extraordinary clinical results and the resulting publicity--such as the 60 Minutes special--have led to a tenfold patient increase in five years. "We don’t have the resources to take care of everybody who needs us,” says Henry Friedman, “but we never tell people we can't help them. At the very least, we try to advise their physicians, and we're developing subsites around the country--centers whose physicians have a reputation for being compassionate and caring and can offer patients access to a full range of treatments."
For more information: Brain Tumor Center