What’s new in treatment of brain cancer?


Local expert says cancer conquest hinges on “many arrows”

Published: 06/11/2015

Local expert says cancer conquest hinges on “many arrows”

The death of Joseph R. “Beau” Biden III, son of Vice President Joe Biden, has put brain cancer center stage in the news. His death on May 30 at age 46 reminds us how far we’ve come — and how far we still have to go — in the fight against cancer.

Biden’s family has released few details about his specific type of brain cancer. It is known he was diagnosed in August 2013 and underwent surgery, radiation and chemotherapy. He reportedly received a clean bill of health that November, only to have his cancer recur this spring.

“Generally, it’s important to understand whether a brain tumor is primary or metastatic,” said Renato V. LaRocca, M.D., medical oncologist, Norton Cancer Institute. “Primary means the tumor originated in the brain. Secondary or metastatic means it spread from another part of the body.”

One of the more common kinds of primary brain tumor is called a glioma. When this type of tumor is malignant, it has a high tendency to recur after initial removal.

Glioblastomas are highly malignant and the most aggressive type of glioma. They account for about 15 percent of all brain tumors, and primarily occur in adults between ages 45 and 70. As this type of brain tumor grows, it leads to pressure on the brain, which can cause symptoms such as headaches, nausea, vomiting, drowsiness and sudden seizures.

High-grade glioblastoma multiforme (GBM) is an especially devastating illness. According to Dr. LaRocca, prior to 2005, average life expectancy was under 15 months for those diagnosed with GBMs, even with optimal treatment. He is encouraged to see these numbers improving.

New advances, promising results

“Over the past ten years we’ve seen tremendous gains in our biological understanding of GBMs, and significant advances in our treatment approaches and options,” Dr. LaRocca said.

One advance is the use of Avastin, an intravenous drug that works by cutting off a tumor’s blood supply. Another new and innovative treatment option is Optune, being used in the Louisville area only at Norton Cancer Institute.

Optune is a unique noninvasive portable treatment device. At first glance, seeing it in use might make you think of a futuristic science fiction movie. Patients wear a skullcap with electrodes that hook up to an electrical field generator than can be carried in a backpack. The generator produces low-dose alternating electrical “tumor targeting fields” (TTFs) that disrupt cancer cells’ ability to reproduce quickly.

Barbara Fendley, who had brain tumor surgery more than a year ago followed by radiation and chemotherapy, is currently using Optune. “This is Star Wars kind of stuff. You get some odd looks when you go out with it,” Fendley said with a laugh. “It takes a lot of commitment because you lose some mobility and freedom, but it’s worth it.”

“It’s not every day with high-grade brain tumors you see the improvements we’re seeing using this technology,” Dr. LaRocca said. He added that Optune’s effectiveness is now being studied with other cancers such as lung, breast and pancreas. “We’re now seeing some GBM patients survive 20 to 24 months, and miraculously, sometimes even as long as five years.”

Any of us who have lost loved ones to cancer can identify with what a precious gift five years could be.

What lies ahead?

Dr. LaRocca points to the emerging field of immunotherapy as an important option that warrants greater research. Norton Cancer Institute has worked on two different vaccines as part of GBM clinical trials. The institute’s effectiveness, according to Dr. LaRocca, stems from a team approach among neurosurgery, neuro-oncology, radiation oncology and neuropathology.

“A lot of state-of-the-art therapy is being done at Norton Cancer Institute that involves vaccines, surgery, radiation, targeted immunotherapy and now TTF,” Dr. LaRocca said. “This multidisciplinary approach gives us many arrows in our quiver to work with. This is how we’ll eventually achieve the conquest of cancer.”

To see a video of Barbara Fendley using the Optune system, go to: https://www.youtube.com/watch?v=cWfHyrKcArg


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