Editor’s note: Researchers have launched a new clinical trial—a research study with volunteer patients—to test a new treatment for brain tumors. In the treatment, a patient first undergoes tumor-removal surgery. Then, a harmless virus delivers two new genes to the brain to kill any remaining cancer cells. One of the genes kills tumor cells directly and the other boosts the patient’s own immune system to attack tumor cells. Patients in the trial will also receive standard chemotherapy and radiation. Two patients are already enrolled. The trial is enrolling patients with grade 3 or 4 malignant primary glioma, such as glioblastoma multiforme.
“University of Michigan Health System doctors have started testing a unique new approach to fighting brain tumors — one that delivers a one-two punch designed to knock out the most dangerous brain cancer.
“The experimental approach, based on U-M research, delivers two different genes directly into the brains of patients following the operation to remove the bulk of their tumors.
“The idea: trigger immune activity within the brain itself to kill remaining tumor cells — the ones neurosurgeons can’t take out, which make this type of tumor so dangerous.
“It’s the first time this gene therapy approach is being tried in humans, after more than a decade of research in experimental models.”
Editor’s note: Oncologists sometimes suggest a treatment based on specific mutations found in a patient’s tumor. People with metastatic melanoma whose tumors have mutations in the BRAF gene are often treated with the targeted drug vemurafenib (brand name Zelboraf). But BRAF mutations can also be found in other types of cancer. This story tells how a patient with a brain tumor that had a BRAF mutation was successfully treated with vemurafenib.
“The BRAF inhibitor vemurafenib (Zelboraf) is approved for treatment of BRAF-mutated metastatic melanoma. There are reports indicating that vemurafenib may be active in the treatment of intracranial neoplasms with BRAF mutations. As reported in the Journal of Clinical Oncology, Lee et al from Brigham and Women’s Cancer Center successfully treated a BRAF V600E–mutated glioma with vemurafenib monotherapy.
“The patient was a 41-year-old man with WHO grade 2 anaplastic pleomorphic xanthoastrocytoma with a BRAF V600E mutation who developed radiographic progression despite surgery, radiation, and treatment with temozolomide. The patient was initially observed with serial imaging for approximately 2 years until magnetic resonance imaging (MRI) showed increased surrounding enhancement. Treatment with temozolomide was followed by radiographic progression after two cycles.”
“Cody Mahan and his family didn’t think they would have to deal with cancer again so soon.”After graduating college, Mahan, 23, had earned a prestigious Department of Defense SMART scholarship and had just started working at Warner Robins Air Force Base. He was looking forward to a promising engineering career.
“In December, he started to experience headaches and then pain in his neck. His family took him to a hospital close to where they lived in Tennessee, suspecting meningitis. Doctors discovered a tumor on the right side of his brain. ‘It was quite a shock,’ says Cody’s mother, Lisa. ‘It was the furthest thing from our minds when we went to the ER.’
“They had thought cancer was behind them. As a teenager, Mahan had ALL (acute lymphoblastic leukemia) and had received full cranial radiation as part of his treatment. At the time, this was a standard prophylactic for patients with ALL. The radiation, his family suspects, may have led to the development of the brain tumor. In fact, radiation exposure is one of the only known risk factors for developing a brain tumor.”
Editor’s note: This well-written story describes a new approach to glioblastoma surgery.
“Agenus Inc said its experimental cancer vaccine helped brain tumor patients live nearly twice as long compared with those who received standard of care treatment…
“The drug, when given in addition to standard treatment, extended median overall survival in 50 percent of newly-diagnosed glioblastoma multiforme (GBM) patients to two years in a mid-stage study.
“GBM patients, who tend to succumb to the disease within one year, are usually treated with a combination of radiation and the chemotherapy drug temozolomide.”
Editor’s note: Prophage is a new “cancer vaccine” that might boost a patient’s own immune system to help fight cancer. Cells from each patient’s tumor are used to personalize Prophage specifically for the patient. This article discusses results from a clinical trial testing Prophage in volunteer patients with glioblastoma multiforme (GBM). Some of the patients in the trial were treated with Prophage in combination with standard radiation and chemotherapy treatment, while for comparison, others were treated only with standard radiation and chemo. The results showed that adding Prophage to standard treatment can help some patients live longer.
Between one-tenth and one-fourth of patients with small cell lung cancer (SCLC) have brain metastases (cancer that has spread to the brain) when they are first diagnosed and up to half will develop them at some point during the course of their disease. There have not been many studies on the use of systemic chemotherapy (ie, chemotherapy in which drugs are allowed to circulate throughout the body) in these patients, but research suggests that it is an effective first- or second-line treatment. Systemic chemotherapy is especially recommended for SCLC patients with brain metastases who do not yet show symptoms.
A study in The Lancet shows that the drug ipilimumab could treat melanomas that have spread to the brain, particularly in people who do yet not have neurological symptoms. Of 51 such patients treated with ipilimumab, 12 had tumors in the brain that shrank or did not get worse and 14 had tumors outside the brain that shrank or did not get worse. Ipilimumab (Yervoy) is an immune system booster that the FDA has approved for treating advanced melanomas.
An experimental drug could help control some melanomas that have BRAF or NRAS mutations, according to a report at an American Society of Clinical Oncology meeting. Tumors shrank or did not get worse in 8 out of 35 patients with the most common BRAF mutation (V600E), and in 6 out of 28 patients with NRAS mutations. This is the first targeted treatment for melanomas that have NRAS mutations. BRAF and NRAS mutations can activate a protein called MEK that is involved in cell division. The experimental drug, which is called MEK162, is a MEK inhibitor. The side effects of MEK162, which included diarrhea, rashes and swelling, were manageable.
An early stage clinical trial suggests that dabrafenib, a BRAF inhibitor, could treat melanomas that have spread to the brain. The study, reported in The Lancet, included 10 people with brain metastases of melanomas that had BRAF mutations. Tumors shrank in 9 patients and were not evident in 4 patients. This is a surprise because the drug had not been expected to cross the blood-brain barrier effectively. Indeed, melanoma patients with brain metastases have been routinely excluded from previous trials of vemurafenib (Zelboraf) and other BRAF inhibitors.
Annals of Cancer Research and Therapy | Sep 28, 2012
Bevacizumab (Avastin), which is approved for treatment of a number of advanced-stage cancer types, is commonly avoided in patients with brain metastases (cancer that has spread to the brain) because of fear of brain hemorrhages (bleeding in the brain). A retrospective study of 52 patients with advanced non-small cell lung cancer (NSCLC) who had received chemotherapy containing Avastin found no cases of serious bleeding events and no significant differences in survival or treatment side effects between patients with or without brain metastases. Avastin may therefore be a safe treatment option in NSCLC with brain metastases.
Research paper: https://www.jstage.jst.go.jp/article/acrt/20/2/20_47/_pdf