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.