New Advances In Cancer Therapies
By Tyler Kang, MD;
The brain is the master of the body, and we know that diseases that afflict the brain can cause significant problems even if other organs remain functional in a person. Similarly, cancers that affect the brain can cause tremendous difficulties and may lead to rapid death due to the critical effects they can have on bodily functions. While the incidence of primary brain tumors is relatively rare in comparison to other cancer types, these cancers usually affect people in the prime of their lives and lead to significant physical, social and emotional issues.
Glioblastoma is a malignant tumor of the brain that is derived from the glial cells, or the support cells of the brain. Its effect is devastating and treatment is usually aimed at delaying recurrence rather than being able to affect a cure of this disease. Part of the reason is that these cancers infiltrate the normal brain, and we cannot take out too much of the brain without affecting critical functions, therefore surgery can never safely remove all of the cancer cells that dwell there. Subsequent treatments such as chemotherapy and radiation can be well tolerated, but only have limited effectiveness and again almost never leads to long-term remission for these patients. Due to something called the “blood-brain-barrier” that the body uses to protect the brain from foreign substances and disease from getting into the brain, typical anticancer therapies usually have a hard time penetrating this and getting into the brain as well, which compounds the difficulty we have with treatment of this disease.
In trying to come up with additional treatments for this disease, investigators have looked into other cancer causing pathways in order to combat the illness. A ground-breaking treatment method was developed known as a tumor treating field (TTF). We know that by applying a certain electromagnetic frequency over cells in a petri dish, the rate at which they multiply is impaired. In glioblastoma cells, applying a certain frequency across them induces cellular death, both in the petri dish and in an animal model. This idea was then carried over to human subjects by using electrodes placed over the scalp. In a major clinical trial study published in 2012, patients with recurrent glioblastoma were randomized to either TTF or physician’s choice of salvage chemo, the outcome of the two arms showed equivalent survival, suggesting that TTF has at least efficacy when compared to standard treatments but with significantly less toxicity. Still, in the minds of skeptics, that without any improvement in efficacy, TTF was still an afterthought compared to the “tried and true” chemotherapies.
That all has changed when in December 2015, Dr. Stupp published a landmark clinical trial in the Journal of American Medical Association, of TTF use in newly diagnosed glioblastoma patient in the up front setting following initial chemoradiation. This study convincingly demonstrated that those patients who received TTF in addition to chemotherapy, improved survival of this group of patients by an unprecedented 5 months, a 33% improvement in longevity, this will become the standard of care for all patients who are afflicted with this devastating illness.
We know that most of the time, science and medicine move in incremental steps in terms of improvement in outcome. But once in a while, when there is a dramatic paradigm shift in thinking about the disease process and pathophysiology, then great strides can be made in the treatment of cancer.
Dr. Kang is a board certified Medical Oncologist and Hematologist with Epic Care, a group of experts in the diagnosis and comprehensive treatment of cancer and blood disorders. For more information visit www.epic-care.com