In this issue
Collaboration Key to Fight against Brain Cancer
Pacific Brain & Spine is dedicated to finding better ways to help patients fight brain cancer. We strive for the best strategies that improve patient outcomes with a systems approach, using advanced technologies, collaborating with teams of specialists in cancer treatment and scientific research, and applying a personalized treatment plan.
Glioblastoma is the most common cancer originating in the brain. Its cause is unknown, there is no clear way to prevent it, and it is very aggressive, having cells that reproduce quickly and are nourished by an ample blood supply. Tumors may be characterized by multiple finger-like tentacles as opposed to a single solid mass, making surgical removal difficult.
Without treatment, a patient may only live a few months and even after maximum, life-extending treatment, this type of cancer usually reoccurs. Glioblastomas are usually complex, containing many different kinds of cells. Furthermore, each patient’s case is different. Given these characteristics, treatment is a difficult challenge for any doctor.
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To successfully remove a tumor deep inside the brain, the surgeon needs tools to see, access, and remove it with precision, avoiding damage to surrounding healthy tissue. This requires pre-surgical planning and mapping of the optimal path to the tumor. Accuracy and precision are especially important since the white matter tracks of the brain can be damaged during surgery, causing compromised motor function, blindness, speech impairment, memory loss, etc.
At Pacific Brain & Spine, Dr. Dickinson incorporates innovations in MRI imaging, access tools with GPS-like navigation, a robotically-controlled surgical magnification system for superior visualization, and sophisticated resection tools that allow the tumor to be safely removed.
In addition to surgery, standard treatment includes radiation therapy and chemotherapy. Determining the best treatment is complicated by the fact that some of the tumor subtypes and genetic variants may be resistant to radiation therapy and the standard chemotherapies.
Furthermore, brain cancer is a highly heterogeneous disease and patients do not respond to treatment the same way. An approach that is effective for one person may not work for another. Often, for unknown reasons, those with the same tumor type who receive the same standard therapy experience different outcomes.
This variability, both in tumor characteristics and patient response, is one of the main factors complicating brain cancer treatment and making outcomes unpredictable.
Given three key factors – the wide array of drugs the oncologist can choose from, the potential variability in patient and tumor response, and the need to identify the best approach quickly – the ideal therapy must be efficient, targeted and personalized to each patient.
Dr. Dickinson, as well as Tyler Kang, MD, neuro-oncologist at Epic Care Medical Oncology Center, and Liliana Soroceanu, MD, PhD, senior scientist in neuro-oncology at the California Pacific Medical Center Research Institute (CMPCRI) are collaborating with the goal of learning the specific characteristics of an individual tumor and then devising the best approach to destroy it. The goal is to prolong the patient’s survival – helping them be as functional as possible for as long as possible.
Upon removing the patient’s brain tumor, Dr. Dickinson transports the tumor tissue to Dr. Soroceanu’s laboratory at CPMCRI. In the laboratory, the tumor cells are kept alive and nurtured to multiply in cell culture medium. This allows Dr. Soroceanu to test the sensitivity of the tumor cells to a broad spectrum of anti-tumor drugs, as well as combinations of these drugs in an efficient, high throughput manner.
The advantage of this approach is that each patient’s tumor can be tested against many drugs. The drugs are chosen to target the most important, disease driving mutations specific for each patient’s tumor. This mutational profile is obtained using next generation sequencing of tumor DNA to determine the tumor’s molecular profile.
Once the most effective agents have been identified, the next step is to test them in a living model. The tumor cells are transplanted into immunosuppressed mice to mimic the human disease and provide a live testing ground. Thus each mouse serves as the living test substitute or “avatar” for the patient, as both are carrying the same cancer.
The mice are treated with those drugs that were most effective in culture, and the mouse’s response is observed. Growing tumor tissue in multiple mice also permits harvesting and analysis at different times, providing information about the tumor’s molecular changes and drug resistance over time. Armed with this patient-specific knowledge of tumor drug sensitivity, Dr. Kang and Dr. Dickinson can offer novel drug treatment combinations for their patients.
This multifaceted approach bolstered by advanced technology, superior surgical techniques, neuro oncology and research expertise, and a patient-derived tumor model increases the body of data and understanding about optimal therapy for specific tumor types, and ultimately has the potential to improve patient outcomes.