New Drug Therapy Holds Hope for Brain-Cancer Patients
Posted March 7, 2007
Durham, N.C. — No one knows exactly why brain tumors form or who will get them, but no other cancer can change the quality of life so quickly. Now, Duke researchers believe they've found something that works for many patients.
Some brain tumors grow very fast and immediately affect your ability to function—to walk, talk or remember basic things. Some tumors can't be treated surgically, and other options may be ineffective.
Two years ago, 29-year-old Tiffany Phillips found it harder to be a mother to her kids. She couldn't even finish the last few courses she needed to earn a college degree in biology at North Carolina Central University.
"I was just sleepy and I just didn't feel good," Phillips said.
Tests showed she had anaplastic cytoma, a Grade 3 malignant glioma, which is a fast-growing brain tumor.
She was asked if she felt any pain. Phillips said, "It was no pain. I didn't have any pain."
"Yes, you did," her mother interrupted. Hilda Hinton is used to filling in the gaps in her daughter's short-term memory. "She had severe headaches. She was staggering, uncoordinated," Hintonsaid.
Radiation didn't help, and the tumor grew back even faster after chemotherapy treatments stopped. Surgery was too risky because Phillips' tumor is deep in the thalamus, the master control center of the brain.
"When you have a tumor in the thalmus, nothing works well," said Dr. James Vredenburgh, a Duke oncologist.
Vredenburgh included Tiffany in a 68-patient clinical trial for a type of chemotherapy called cpt-11 plus another drug called Avastin. Today, Avastin is approved for use with metastatic colorectal cancer and lung cancer.
As tumors grow in certain parts of the body, they send out a protein growth factor that attracts new blood vessels. Avastin interferes with those signals, so the tumor starves.
Still in treatment, Tiffany's tumor is shrinking. Her condition is still guarded, "but we're optimistic with some of our new clinical trials that we will be able to control her tumor long-term," Vredenburgh said.
The tumor already has caused some irreversible damage in Tiffany's brain, but Hinton says her daughter has made great progress. She's learning to work around some of her short-term memory problems by writing things down more.
Not perfect, Hinton said, "but I feel if she can get back to 85 percent, 90 percent, I'll take it.... I'll take it and run with it."
Vredenburgh credits Avastin for the dramatic improvement in many patients like Phillips in the trial.
"I think it's the major source of improvement because we did a number of clinical trials with just cpt-11, and about 10 percent to 15 percent of people would respond. We've not seen the dramatic clinical improvements like we've seen with Tiffany with just cpt-11 alone."
Avastin does come with certain risks, like raised blood pressure, increased protein in the urine and increased blood clots in the legs, so it's been used only where other therapies have failed. Phillips met the strict criteria that Duke requires for its trial.