Precision medicine is revolutionizing cancer treatment. Instead of using the same treatment for the same type of cancer, precision medicine tailors treatment to each individual. Precision medicine—also known as personalized medicine—takes into account someone’s genes, lifestyle and environment to find the most effective course of action for them.
“Ten years ago we diagnosed and treated cancer based on what part of the body it was in and what the cancer looked like under a microscope,” says James Snyder, D.O., a neuro-oncologist with Henry Ford Health. “Now we're less concerned with what it looks like and more concerned with its intrinsic biology: how is the tumor growing in this individual? How can we stop this person’s biological pathway that's allowing the cancer to grow? Precision medicine categorizes cancer not by where it is but by the genetic makeup of the tumor itself.”
Many innovative treatments are in clinical trials to improve and extend the lives of those diagnosed with brain tumors--including glioblastoma, a notoriously difficult brain cancer to treat. Here, the advancements that are making waves in brain cancer treatment.
Historically, standard-of-care treatment for metastatic brain tumors has involved surgery, and then within several weeks, as many as 10 visits for conventional radiation. With GammaTile—a new type of surgically placed radiation—one area of the brain is targeted with radiation treatment directly after tumor removal.
Here’s how it works: Radiation is embedded into a collagen sponge, encapsulated in titanium and placed into the brain right after you’ve had surgery to remove a brain tumor. “The radiation immediately begins to treat the area adjacent to where the tumor was removed, which is where most recurrences happen,” says Adam Robin, M.D., a neurological surgeon with Henry Ford Health. “That area has the highest density of residual cells that you can’t necessarily pick up on an MRI.”
GammaTile allows you to go about your daily life while undergoing treatment. You’ll receive most of the radiation within the first month. By the third month, there radiation is nearly gone. For the first few weeks, it’s recommended not to ride on public transportation, sleep in the same bed as anyone else or get close to pregnant women. There are very few other limitations.
“GammaTile is beneficial for those who don’t have any treatment options left,” says Dr. Robin. “And it’s a great option for people who may not be able to come back for radiation because of access-to-care barriers. Early data suggests it reduces the likelihood of an immediate cancer recurrence.”
Over the last 15 years, we’ve learned that fragments of genetic information are constantly deposited into the bloodstream by all types of cells--including cancers cells. This means that instead of using invasive, surgical biopsies to identify whether tumors are benign or malignant, we can increasingly use a blood or spinal fluid sample—what’s called a liquid biopsy.
Liquid biopsies may be able to distinguish between different types of cancers and malignancies, and they can monitor a patient’s response to treatment. "In fact, Henry Ford is a national leader in liquid biopsy research for brain tumors of all types," says Dr. Snyder, "and we recently published two papers on the subject." This easier, less invasive biopsy will likely be a total game changer over the next 10 years.
An avatar is a tumor sample that is taken from the patient and grown outside of them (in a mouse for example). This allows doctors to analyze the tumor and investigate different treatments to see what will be most effective to eliminate it.
“While someone is undergoing treatment (and while we hope the current treatment is working) we have this model to see how the tumor cells are growing,” says Dr. Snyder. “We’re able to expose the person’s tumor to different types of medicine to see how it responds. We could treat someone based upon what we see in their avatar—it’s taking personalized medicine to another level.”
While in early research stages, tumor avatars are an area of excitement for the future.
“With many illnesses, your immune system attacks infected cells to defend your body,” says Ian Lee, M.D., a neurological surgeon with Henry Ford Health. “But with cancer, somehow these tumor cells get past the body’s immune system detection. The immune system doesn’t know the cancer cells are harmful and lets the tumor grow. Brain tumors in particular are known for their ability to sneak past the immune system.”
Immunotherapy harnesses the strength of your immune system to defend itself against cancer. “In other cancers, we’ve had major breakthroughs with immunotherapy, so we’re hoping it can help those with brain tumors as well,” says Dr. Lee.
There are a variety of ways to teach the immune system that tumor cells are dangerous and attack them as such:
- Create a vaccine using the patient’s tumor tissue. Take immune cells and part of the brain tumor outside of the body and mix them together to “educate” the immune system to go after the tumor.
- Use viruses as an immunotherapy drug vehicle. “It’s really hard to get drugs into the brain—the body does a great job of trying to protect the brain,” says Dr. Lee. “A virus would essentially be used as a tool to engage the immune system. It would take away the isolation tumor cells have in that protective brain environment.”
- Manipulate the body’s own inflammatory response to fight the tumor using checkpoint inhibitors (otherwise known as PDL-1 and PD-1 inhibitors).
- Use CAR T-cell therapy, which is in clinical trials for glioblastoma. "The patient's white blood cells are labeled with a tumor-specific marker, which then acts as a 'heat-seeking missile' to specifically target tumor cells," says Dr. Lee.
5-ALA (Or “The Pink Drink”)
Known colloquially as the Pink Drink, 5-ALA is a drug that’s taken by mouth before surgery. It turns the brain tumor fluorescent pink under ultraviolet light so the tumor cells are more visible, even those that are beyond detection to the naked eye. When the tumor fluoresces, surgeons can more easily differentiate healthy cells from cancer cells, so they can get rid of all of the tumor tissue and keep all of the healthy tissue.
“We are really hopeful that all of these technologies can change the outcome of brain cancer and even those diagnosed with glioblastoma,” says Dr. Lee. “There’s still a lot of work to be done, but we’ve made incredible advancements within the last fifteen years. We are increasingly improving their quality of life.”
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Dr. Adam Robin is a neurological surgeon specializing in neuro-oncology at the Hermelin Brain Tumor Center. He sees patients at Henry Ford Cancer - Detroit, Henry Ford Hospital and Henry Ford West Bloomfield Hospital.