Imagine your daughter wakes up with a headache and
difficulty expressing her thoughts. At an emergency room, a CT scan followed by
an MRI brings frightening news: a brain tumor.
Such scenarios occur several times a week in hospitals
scattered throughout the Pacific Northwest. In each instance, both patient and
family are faced with urgent questions for which many doctors are ill prepared.
What kind of tumor might this be? Is it life threatening? Is urgent surgery
needed? Will the surgery require specialized techniques? Are there nuances in
diagnosis and subsequent treatment?
One of the most pressing demands for patients newly
diagnosed with a serious disease is to gather accurate information as quickly
as possible. For brain tumor patients, this search is complicated by the
"orphan" nature of these tumors, where the rarity of the disease can mean
limited research efforts, fewer advances in understanding and treatment, and
limited availability of treatment centers.
The current state of affairs is changing rapidly as
clinicians and laboratory scientists bring advanced treatment approaches to
bear on this difficult problem. In 2009, the FDA approved another new
treatment, called bevacizumab (trade name: Avastin), for highly malignant
glioblastoma (GBM.) Bevacizumab is an antibody that alters abnormal vessels
within tumors to restrict the supply of nutrients and to reduce swelling.
Avastin is the third new treatment recently approved for GBM.
But such progress is only the starting point. As neuro-oncology
enters the future side-by-side with other fields in oncology, Seattle has much
to offer these burgeoning groups of brain tumor clinicians and scientists. The
Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment (CABTT) at
Swedish Medical Center/Cherry Hill, for example, provides a variety of
specialty care from advanced diagnostic neuroimaging to cutting-edge
neurosurgical techniques.
Seattle's Institute for Systems Biology is working with
Swedish to profile the expression of tens of thousands of genes in the tumor
tissue of several hundred brain tumor patients. Since every patient's tumor has
a unique set of genetic abnormalities, such profiles will one day be used to
design treatments that will be the most effective for an individual patient's
tumor. Thanks to a major gift from the Ben and Catherine Ivy Foundation, the
Allen Institute for Brain Science is working to produce a human brain tumor
atlas that details the patterns in which the abnormal genes are expressed
throughout the tumor mass and surrounding brain as it is infiltrated by tumor
cells. Accium Biosciences has sophisticated technology called an accelerator
mass spectrometer, which permits the detection of single chemotherapy
molecules, such that the absorption, distribution and cancer-killing properties
of the drug can be traced within a patient's body as well as in the brain
tumor.
This technology also can be used in the targeting of
treatments to a key subset of cells within tumors known as tumor stem cells.
Those cells that are resistant to anticancer treatments and can grow back to
cause tumor recurrence are known as cancer stem cells. Major research efforts
are under way to characterize these cells and find new ways to specifically
target treatments for them.
The future is bright for rapid advances in brain tumor
research and treatment, and the availability of specialty treatment centers is
an important development. Patients who are diagnosed with brain tumors today
are no longer orphaned in Seattle. We're working on it.
John W. Henson, MD, FAAN, is director of the Center for
Advanced Brain Tumor Treatment at the Swedish Neuroscience Institute.