One day, perhaps in the next five years, I will develop a malignant brain tumor called a glioblastoma that could take just 15 months to kill me.
As a former practicing doctor, I know that these tumors are some of the hardest to treat — which is why this short prognosis has remained largely unchanged for the past decade.
But radical thinking is starting to yield results. For example, an innovative “anti-cancer hat” has been so successful that trials have been cut short to allow more people to benefit from this approach as quickly as possible. Other unconventional treatments are also moving forward in trials.
My medical career ended the day I was diagnosed with a glioma brain tumor, back in 2008. While it was surgically removed several days later, the cancerous growth had already seeded my brain with microscopic deposits, which will help it to return as an angrier and more aggressive glioblastoma. In 2008, I was given a 50 percent chance of making it to 2020, but — who knows? — one of these new options may help me live longer.
When a tumor is buried deep within the brain, removing it via traditional surgery risks causing brain damage. Nanotechnology, using a microscopically small scale, is a safer alternative. A technique dubbed NanoTherm involves injecting tiny metallic spheres into tumors. When agitated using a strong alternating magnetic field, these spheres heat up to 176 degrees to cook and cauterize a tumor from the inside.
Created by a team at the German firm MagForce, this approach is being tested as a method to boost the power of chemotherapy and radiotherapy for treating glioblastoma tumors. Early trials have been a success, and MagForce’s Hoda Tawfik says that some recipients have lived for nine years after diagnosis. Larger trials are underway.
A potential cure for me? Tawfik hedges her bets, explaining that this treatment will work best alongside others. “We do not have a cure,” she says, but adds that the work so far can “offer hope of long-term survival.”
In November, Roger Stupp at the University of Zurich proclaimed the birth of “a new standard of care for patients suffering from glioblastoma.” Speaking in Miami, he was describing an anti-cancer hat — the NovoTTF-100A, to give it its official name.
Twenty years in development, it doesn’t have the pipes and metalwork I would expect from a cancer-killing machine. It’s more like the sort of thing Apple would design: a white skullcap attached to a battery pack.
It is designed to be worn for 18 hours a day while ceramic transducers within the hat pulse alternating electrical fields into the brain. These fields interfere with the protein framework essential for cell division, preventing the replication of malignant tumor cells, which divide far more often than healthy adult cells.
An ongoing trial of people receiving chemotherapy while wearing the device has found that they are 50 percent more likely to be alive two years after diagnosis than those receiving standard treatments. These mid-trial results were so impressive — a survival rate of 43 percent vs. 29 percent — that the test is due to end early so that more people can use the device as soon as possible.
David Stocker, of the device’s manufacturer, Novocure Europe, says the hat has been too much like science fiction for some, who believe the use of electric fields in medicine has more to do with quackery than science.
“Many researchers and academics have a hard time understanding how the system works,” he says. “It is only now that we have the trial results to show beyond any doubt that it does actually work.”
The NovoTTF-100A is no silver bullet, though: It usually adds only months to life, effectively slowing but not killing the cancer, although some users have gone on to live for more than 10 years. I would be interested to know if it could be used for people like me, whose tumors have not yet progressed to a highly aggressive glioblastoma.
A cheaper alternative might be a personalized vaccine called DCVax. Developed by NorthWest Biotherapeutics in Bethesda, this approach uses a person’s own immune system to attack his cancer.
Cancer vaccines have been tried before, but virtually all have failed. Linda Powers of NorthWest Biotherapeutics says most existing attempts are “trying to rehabilitate immune cells that have already been hobbled by the cancer.” Her firm’s solution is to rekindle a person’s exhausted immune system by growing new white blood cells for them.
The idea is that bone marrow cells that haven’t yet matured into immune cells are extracted from a person’s blood and nurtured in the lab into dendritic cells — the army generals that organize the rest of the brain’s immune system. Exposing these cells to biomarkers from the person’s tumor primes them to seek and destroy that particular cancer. The finished batch of activated, educated immune cells is then injected into the person’s blood to do their work.
Early trials show promise. One trial had an average survival of around three years, and in some tests, a few individuals have survived more than 10 years — eight times the average of 15 months.
Applying this technique to an earlier-stage glioma like mine might prevent it from mutating into a glioblastoma. And because it would be my immune system doing the work, there are likely to be relatively few side effects. For now I’m crossing my fingers: Randomized trials are now recruiting, with early results expected later this year.
Meanwhile, Dror Harats of Israel-based VBL Therapeutics thinks he may have devised a gene therapy technique that could change my future. His strategy hits cancer cells’ ability to divide by targeting their blood supply and starving them of the fuel they need.
As a tumor grows, it releases chemical messengers that trigger new blood vessels to grow toward it, feeding its appetite for oxygen and nutrients. Through 20 years of research, Harats discovered that the cells lining these newly forming capillaries have unique genetic features that can be exploited. His team has genetically engineered harmless adenoviruses to infect the capillaries’ cells and insert a gene that triggers them to self-destruct.
In early human trials, this experimental treatment, called VB-111, has fared remarkably well, apart from some flulike symptoms. When tested on 46 people with glioblastoma for whom all other treatments had failed, those who received repeated injections of virus particles alongside standard drugs survived for 18 months — much longer than the average life expectancy for such patients of around six months.
If these numbers hold up under repeated testing, VB-111 will be a breakthrough, offering a longer, better quality of life. It wouldn’t work for me yet, but it could be an option once my tumor becomes a glioblastoma. But speaking personally and not as a doctor, I confess I have some irrational hang-ups about a genetically engineered virus coursing through my blood.
As a doctor, I am encouraged that these treatments offer serious potential, and as a patient, I’m excited by what they could offer me. I would jump at the chance to get a nanoparticle injection instead of an operation, and the anti-cancer hat could well treat my tumor while I live a normal life, walking the dog or doing the shopping. Although none would count as a cure, each of these treatments boasts a handful of long-term survivors, and over the next five to 10 years, it is possible that combined therapies could turn this terminal condition into a controllable one.