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Forbes: Brain Cancer Like McCain's Has Hundreds of Experimental Therapies

Sen. McCain

The type of brain cancer John McCain was diagnosed with July 14, glioblastoma, is among the most difficult cancers to beat. The reasons it’s so hard to treat, as I discussed previously, include its location, its genetic diversity within and across patients, and its aggressiveness. Glioblastoma (GBM) is also among the most devastating cancers in its effects since it attacks the brain, the control center for the body’s functions and the essence of an individual’s personality. Even people who survive rarely remain the same person after their treatment.

The standard of care typically begins with the kind of surgery McCain already had, an excision of as much of the tumor as possible. Next is a combination of radiation and the chemotherapy drug Temodar. Without treatment, median survival is three months, but radiation quadruples that and Temodar adds a few more months. Many patients also receive Avastin (bevacizumab), a drug that prevents new blood vessel growth to reduce swelling. But Avastin does not extend survival; it’s a palliative measure to reduce discomfort.

After that standard regime comes any of hundreds of experimental treatments, usually through clinical trials.

“They’ve tried a lot of things and nothing’s worked,” said Eric Holland, M.D., Ph.D., director of the Human Biology Division and senior vice president at Fred Hutchinson Cancer Research Center in Seattle. “Everyone has to provide the standard of care—you can’t not give it. The question is whether there’s anything you can add to make it work better, and there’s not.”

But the perversely positive side of that reality is that researchers are willing to try pretty much anything with this cancer—and they are. Hundreds of potential therapies are in clinical trials right now, perhaps with greater diversity than seen with any other cancer.

“Because the outcomes are so bad with GBM, GBM patients are on the front line of clinical trials,” said Tom Curran, Ph.D., past president of the American Association for Cancer Research and the Donald J. Hall Eminent Scholar in pediatric research at Children’s Mercy in Kansas City. “You go into clinical trials because you don’t have hope in traditional therapy. Patients are willing to fight, willing to take the chance and take experimental therapies because they have hope, and I think John McCain is an exemplifier of that.”

Identifying those individuals who respond very well to a treatment—even if others in the trial don’t—is instructive as well, Curran said.

“Every now and again, there’s a rare occurrence of a really dramatic response in a patient, and the National Institutes of Health has recognized that these outliers are really significant,” he explained. “Even one patient responding to a specific agent could be extremely informative, so the rare patients that show really wonderful responses are teaching us.”

“Even one patient responding to a specific agent could be extremely informative, so the rare patients that show really wonderful responses are teaching us.”
Dr. Tom Curran, Children’s Mercy Chief Scientific Officer and Executive Director of the Children’s Research Institute

Curran pointed to support for cancer research at the National Institutes of Health (NIH), including from Congress members such as McCain in the past, as a vital component of improving survival odds for those with glioblastoma.

“It’s very important to understand the genetic and biological diversity of tumors because in the end, the treatment approach is likely to be very individualized,” he said. “It is highly likely that McCain will receive that kind of analysis in the off chance that there is something hidden in the genome of the tumor that uncovers an Achilles’ heel. It’s rare—you can’t bet on it—but at least you can hope on it.”

Even when progress doesn’t appear obvious based on the lack of successful therapies, each trial teaches scientists more, and past advances in cancer treatments have shown how that gradual accrual of knowledge can suddenly merge into a great stride ahead, though there’s no way to tell if that’s five or 15 or 50 years away.

“Technologically, we’ve moved significantly over the last decade,” Curran said. “We know more, and immunotherapies are offering potential treatments that we never thought could have existed in the past only because of NIH-supported research.”

McCain’s reputation as a fighter and a hero in many circles offers an apt analogy for the way scientists approach cancer research, Curran added.

“His heroic character was exemplified by one thing: not because he survived torture, not because he was captured, but because he chose not to be relieved of imprisonment until the rest of his fellow soldiers were also released,” Curran said. “That’s how we approach cancer research. It’s not about developing new treatments and therapies for rich people or for people who have access. It’s for everybody.”


Article written by Tara Haelle.

Read the full article via Forbes.

Learn more about the Children's Research Institute at Children's Mercy Kansas City.