LI patient, doctors hopeful on brain cancer vaccine

Dr. Jai Grewal, a neuro-oncologist and co-director of

Dr. Jai Grewal, a neuro-oncologist and co-director of the Long Island Brain Tumor Center, and Dr. Lee Tessler, a neurosurgeon. review images of the brain. (Sept. 27, 2012) (Credit: Newsday / Audrey C. Tiernan)

The 54-year-old Long Island patient is upbeat and hopeful, confident that a vaccination she received a few months ago has set her on the path to long-lasting health.

Yet, the shot in the arm was unlike an immunization against measles or the flu. Her vaccine is against the rebound of the deadliest form of brain cancer: glioblastoma.

Withholding her name out of fear of recriminations in the job market if future employers were to discover her diagnosis, the patient is crossing her fingers that the vaccine works.


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She is a pioneer in what many doctors think will become standard treatment in the not-too-distant future: a shot in arm against the recurrence of cancer.

For more than 20 years, medical scientists have been chasing the possibility of preventing the comeback of a variety of cancers by developing a vast number of experimental vaccines.

Vaccine clinical trials are under way for pancreatic cancer, malignant melanoma and breast cancer, to name a few. Some vaccines have proved promising; others have forced scientists back to the lab. In 2010, the drug Provenge, designed to fend off advanced prostate cancer, became the first anti-tumor vaccine to be approved by the U.S. Food and Drug Administration.

Medical investigators vow it won't be the last.

 

Initial results encouraging

Developing effective treatments against the worst form of brain cancer is important, doctors say, because the survival rate now is dismal, at best. Only 26 percent of patients are alive two years after diagnosis.

Equally troubling, the cancer -- though rare -- is part of a larger puzzle: An increasing number of brain tumors of all kinds are occurring nationwide.

Dr. Jai Grewal, co-director of the Long Island Brain Tumor Center in Rockville Centre, said the patient knew she faced difficult odds when her diagnosis came back grade-four glioblastoma multiforme, the worst possible stage.

"Glioblastoma is the most aggressive type of brain cancer," said Grewal, whose tumor center is part of Neurological Surgery, P.C., a practice with divisions in Nassau and Suffolk counties.

Median survival with this form of brain cancer is 12 to 14 months, he said, and many of the affected patients die in the prime of life.

"We decided to offer this clinical trial because preliminary data from earlier studies showed the vaccine improved survival," said Grewal, who is working with hospitals throughout Long Island to recruit patients into the investigation.

Since the vaccine is still experimental, the retail cost of the treatment has yet to be determined.

A series of small, earlier studies conducted by the vaccine's maker -- Northwest Biotherapeutics in Bethesda, Md. -- revealed nearly hard-to-believe results.

Median survival was three years, Grewal said, with 33 percent of patients still alive after four. Further data, contained within the company's 2010 report, showed 27 percent of treated patients living six years or more. The longest surviving patient lived 10 years after vaccination.

"That's the part that was really important," said Grewal, a neuro-oncologist, who underscored that other experimental brain cancer vaccines didn't come close to those statistics.

Known as DCVax-Brain, the vaccine is called "personalized" because it involves removing cells from the brain tumor as well as isolating a sample of the patient's own dendritic cells, master constituents of the immune system. Both are sent to Northwest Biotherapeutics.

Dendritic cells help direct how effectively the body fights diseases of all kind. They can be aces at mobilizing the entire immune system to fight a specific cancer when fully "trained" to do so.

Tumor tissue and the patient's dendritic cells are united in the lab, where biomarkers on malignant cells are used to activate the immune cells to attack the cancer. The primed dendritic cells are injected back into the patient as a vaccine.

Periodic boosters are required to retain immunity.

Patients also receive standard chemotherapy and radiation for more assurance against the cancer's return.

 

It started with headaches

Grewal's patient, a lifelong Bethpage resident, received her shot more than six months ago.

"I feel great," she said recently. She said she has returned to work and resumed her usual routines.

Still, she wonders how she developed such a horrific cancer, and one for which medical scientists are still searching for effective treatments. Her brother, she said, also developed brain cancer -- but a different tumor type.

"In the neighborhood where I grew up, there are a lot of people who have had cancer," the woman said.

Her first inkling that something was awry arose last fall.

"I started to get headaches," she said. "And at first, I just thought it was pressure at work. So I started self-treating -- taking Aleve and Advil," she said of two over-the-counter pain remedies.

"But the headaches kept getting worse and worse," she said.

Ultimately, the source of those headaches also played havoc with her memory and perception. Her symptoms caused panic among relatives, who advised her to seek treatment in an emergency room, especially after an episode when she remarked being unable to find her keys and cellphone, both of which she held in her hand.

Tests revealed a large tumor in her brain.

Dr. Lee Tessler, also of the Brain Tumor Center, was the patient's neurosurgeon.

"I took out an 8-centimeter right frontal tumor," he said of a cancer that measured about 3.1 inches.

Putting the tumor's size another way, a standard-size baseball is about 2.9 inches in diameter. But glioblastomas have an insidious growth pattern, Tessler said. They are not a distinct bundle that can be easily plucked out. Instead, they produce tentacles that insinuate themselves into the brain.

"In the front part [of the brain], tumors can grow relatively large before they're noticed," Tessler said. "Glioblastomas grow by spreading out in the brain."

 

Cause remains a mystery

Inexplicably, the incidence of all types of brain tumors, including nonmalignant ones, is rising nationwide, according to the National Brain Tumor Society in Boston, a nonprofit advocacy organization.

More than 688,000 people in the United States are living with primary tumors of the brain -- cancers that originate there, not ones that traveled to the brain through other forms of cancer. Fortunately, most of the tumors -- 550,000 -- are nonmalignant. But the incidence is up from an estimated 612,000 people living with malignant and nonmalignant tumors in 2004.

Even though a smattering of unsubstantiated studies have pointed to everything from aspartame (artificial sweetener) to cellphones to the electromagnetic current emitted from high-voltage wires, no one knows why the incidence of brain tumors is increasing.

With glioblastoma, Tessler said, there is still much to be learned about its causes.

"We know a couple of things can cause it," Tessler said. "Exposure to large amounts of radiation and there are also certain genetic syndromes. But in the end with most people, we just don't know why they occur."

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