Brain Tumor Surgery | Immunotherapy
| Overview | Procedures |
Results
Results of the Phase 1 MLC immunotherapy trial 1996 -
1998
A "Phase 1" study is performed to detect toxicity of a new experimental
model. Of the 19 patients in the Phase I trial, there was no toxicity within
a certain dose range of activated white blood cells, and 25% of the patients
enrolled (1 patients with glioblastoma multiforme and 2 with anaplastic astrocytoma)
are currently in complete remission with no evidence of active disease since
their implantation in 1996.
.
Glioblastoma Multiforme (Grade 4 astrocytoma)
Before and 3 1/2 years post immunotherapy. Biopsies of the residual
mass on the right showed only dead, necrotic tissue.
CURRENT TRIAL - Hoag Memorial
Hospital Presbyterian
Malignant Brain Tumor Treatment Protocol
Current Trial
Hoag Memorial Hospital Presbyterian (Newport Beach, CA)
Christopher M. Duma, MD
Neurological Surgery, Gamma Knife Radiosurgery
Neurosurgical Oncology
The goal of the
program is long-term survival, and attempts at a "cure" of perhaps
one of the most difficult tumors to treat. This, in our opinion, is only
possible using a combination of conventional therapies and various biological
techniques. Surgery, radiation and chemotherapy alone are not the answer.
Our protocol for a newly diagnosed tumor is as follows,follows; of course
any patient may enter the protocol at any point depending upon their previous
treatment strategies.
1A) Gross total (radiographically
complete) tumor resection using specialized
stereotactic neuronavigational techniques. It has been shown that when this
is possible it markedly extends the patient's chance of survival. Unfortunately
it is not always possible for all tumors. Or,
1B) Stereotactic, MRI-guided biopsy (for tumors difficult to fully resect
or tumors in eloquent locations in the brain).
2) Tissue from 1A and 1B above is sent for chemosensitivity
assay and/or vaccine production.
3) Gamma Knife Radiosurgery Boost to all abnormal
tissue and if possible treatment of "the leading edge" of the
tumor tracts (fingers) seen on post-operative scans. One day procedure.
This alone has been shown to double the median survival. It is often directed
by MR Spectroscopy, a technique which requires only a MRI scan, but the
scan shows spectroscopic patterns which show live tumor molecules or dead
tumor molecules.
4) Involved-field, conventional radiation
therapy. (5-6 weeks) This has
been shown to double life expectancy.
5) Chemotherapy. This is directed by the results of #2 above. The original
tumor is grown in tissue culture and then exposed to different chemotherapy
agents. Then selective sensitivity is then determined. In some cases tumor
is only sensitive to certain agents and in others not at all. There is no
sense in giving chemotherapy and compromising the immune system if the tumor
will not respond.
6) IL-2 activated autologous lymphocytes. Our longest
survivors had enrolled in this protocol. We have resumed this protocol
at Hoag Memorial Hospital, and intend to use it in a series of 30 up-front
patients. This means that only patients with newly diagnosed glioblasotomaglioblastoma
multiforme are eligible. The lymphocyte portion of a peripheral blood draw
is extracted and exposed to the cytokine IL-2 in vitro. This exposure activates
the patients’ autologous
cells over a 3-day incubation period. They are then implanted into
the tumor bed after a thorough resection to debulk the residual/recurrent
tumor.
7) Re-operation for a radiographically complete resection, possible implantation
of Gliadel chemotherapy wafers, and return to step #2 above.
We have been using the above protocols for all of our patients with anaplastic
astrocytoma and glioblastoma multiforme and other malignant gliomas (oligodendrogliomas,
mixed tumors, etc.) We are following some patients who have completed only
up to step 3 since 1997 without a recurrence. Thus some of my patients are
in complete remission with only the initial phases of this regimen.
Please send your films and a short history to my Orange
County office in Newport Beach, California. Wewill enter you into our data
base, present your films free of charge at our weekly Gamma Knife, multidisciplinary
Tumor Board, and get back to you by telephone or by mail with our recommendations.
Otherwise, preferentially, please make an appointment at my office
to discuss these options in person.
Brain Tumor Surgery | Immunotherapy | Overview | Procedures | Results
For consultation appointments with Dr. Duma or
for more information regarding his brain tumor, GammaKnife radiosurgery,
and Parkinson's Disease programs at Hoag Memorial Presbyterian Hospital
in Newport Beach, California (Orange County), please contact:
949-642-6787
Or E-mail Dr. Duma directly: drduma@cduma.com
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