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Melanie Cole (Host):  Recent media coverage has focused on possible new treatments for brain tumors. My guest today is Dr. Benjamin Purow. He is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors. Welcome to the show, Dr. Purow. So there has been some coverage recently about new potential treatments for brain tumor, so talk about some of those recent developments.

Dr. Benjamin Purow (Guest):  Certainly, certainly, and thank you for having me. You know, there is really growing excitement in this field, as I would say, there is a cross oncology, but there is lot of it focused in neuro-oncology and brain tumors. We had a big brain tumor meeting back in November several months back and there were few exciting developments there which, you know, I have to say is all too unusual at this meeting.
You know, one of these was combining very unusual new treatment which actually involves electrical currents to the skull to the region of the brain tumor, combining that electrical treatment with radiation and a chemotherapy we use a lot called temozolomide and this combination for patients that had recently been diagnosed with glioblastoma, the most common and aggressive brain cancer that’s out there, led to some exciting results in the clinical trial.
There was another positive clinical trial that was announced at this meeting, which combined in immunotherapy essentially a vaccine against a mutation only found in about a third of glioblastoma patients but only in those cells in the body, that particular mutation combining that vaccine with a drug called avastin which attacks the blood supply but may also have some good effects on the immune system which prompted that clinical trial which again had positive results which is also super. You know, there is a bit of other positive results announced at this trial using this avastin medication in a subset of patients with glioblastoma, but a lot of enthusiasm at the meeting was focused on new immunotherapy treatments that rev up the immune response against the cancer, and there are different ways to do this. A couple of exciting presentations with the meeting involved a polio virus treatment which is being pioneered at Duke University. They use polio, basically a weakened and attenuated polio virus, and inject it right into a piece of a location of recurrent glioblastoma cancer. Another couple of things: they’re trying to directly kill the cancer cells there in the brain but it also seems to attract the immune system’s attention because of the polio virus infection. An immune system then turns around and attacks the tumor. They have a couple of patients who have done great for a long time with this treatment. There was another viral therapy being pioneered at MD Anderson Cancer Center in Texas that also looks very promising, but there are a number of other immunotherapy that are looking great now too. There are some other cancer vaccines which are starting to show some exciting results. On top of that, there are some therapies that are already out there and FDA-approved for melanoma that people are increasingly excited about for glioblastoma, other brain tumors and cancers across the board. These are treatments that can be given IV every couple of weeks and they rev up the immune system, somewhat nonspecific so there are some risks to these drugs like autoimmune diseases. But they seem to be a great way to get the immune system engaged in fighting the cancer, and everyone is awfully excited about these drugs and some of the combinations that we’ll be doing. 

Melanie:  So most of these immunotherapies and vaccines and really exciting new treatments that you are describing, they are in clinical trial phase. When do you, in your opinion, see some of these coming to the forefront where they might actually benefit some patients?

Dr. Purow:  Sure, sure. So for some other cancers, as I said, for melanoma and actually one of these for lung cancer are already FDA approved. Insurance won’t cover this but a few patients are trying to get some doses of this paid for out of pocket. So a few patients are already accessing this immune system boosters we call check point inhibitors and drugs like nivolumab or [pembrolizumab] but the trials I think will move fairly fast, and [recurring] patients certainly fast too, so it may just be a matter of couple of years, few years, before there is evidence of the fact and FDA approval will hopefully come pretty quickly, especially since these are drugs where they are already FDA-approved for certain settings, patients with melanoma, or already lung cancer has been added to melanoma.

Melanie:  Now patients with glioblastoma, you mentioned earlier electrical fields and I know your colleague Dr. David Schiff was involved in this wearable device, tell us a little bit about that trial.

Dr. Purow:  Sure, sure. So, you know, the great results from that trial I have to say came as a bit of a surprise to the field in a way. It stems from, you know, this is a very unusual treatment, as I started mentioning before. It essentially involves putting electrode patches up on the skull in the region roughly over where the brain tumor is. These electrode patches are wired to a battery pack you carry around that applies alternating electrical current to that region of the head. We have some good research that led into this, mostly out of Israel, that show that these electrical currents can actually lead to killing of glioblastoma cells especially if the current hits the dividing cell, dividing cancer cell, at the right orientation. There had been trials of these electrical treatments in patients that had recurrent glioblastoma when the cancer came back again, and this actually prompted FDA approval of the device in this setting, although the effectiveness of this in that setting, you know, glioblastoma coming back wasn’t traumatic. But, you know, there is a hint that it was about as much as some chemotherapies we use that can have some marginal benefit but very safe; it only seems to cause a little bit of skin irritation. But in this new trial, this was combined with the upfront radiation and chemotherapy that we use, a drug called temozolomide, and then the effects seem much more dramatic. You know, it really led to a significant lengthening of people’s lives. This sort of hit like a bit of a bombshell and there may be an extension of the FDA indication for two patients who, you know, were recently diagnosed and just got the radiation and using this alongside the upfront chemotherapy. So, you know, this another exciting new development in the field. 

Melanie:  Dr. Purow, I know you are very excited about the immunotherapies and all of these trials, since we last talked you’ve been on the show with us before, what are some new areas of research that you are focused on?

Dr. Purow:  Sure, sure. So I spend about a quarter of my time seeing patients and then three-quarters of the time in my laboratory and we are trying to figure out some new and creative ways to attack these diseases. We focus mostly on glioblastoma in the laboratory and we are attacking glioblastoma at multiple levels. We are also finding the several of our projects seem to have potential for other cancers as well. One of the things we’ve been doing is repurposing existing drugs or recycling some abandoned drugs, you know, not only to block an exciting new target called DGK Alpha or diacylglycerol kinase alpha. You know, it’s one that we think hits the cancer at multiple levels, directly killing cancer cells, attacking the blood supply, but there is also potential to rev up the immune system against the cancer. So I think this may be a great combination with some of these hot new immunotherapies.
You know, we are also repurposing existing drugs to suppress some promising known targets. There are drugs out there that are in light use that have some anti-cancer properties that haven’t even been really figured out. We think we are nailing down the important effects for at least one of these drug classes out there. We’re also looking at some new projects where we think we figured out new vulnerability of subtypes of glioblastoma and other cancers.
There are some subgroups within glioblastoma that you see similar general types in other cancers as well, so we are trying to figure out some Achilles’ heels for those and have some new ideas there. You know, we are also trying ways to maximize the effects from existing drugs, combinations and ways to sensitize to some of the existing armamentarium against cancer. Some of those things are starting to look promising as well.

Melanie:  It’s absolutely fascinating, Dr. Purow. You can hear the passion in your voice. What an amazing doctor you are! In just the last minute, why should families come to the UVA Neuro-oncology Center for their care?

Dr. Purow:  Sure. You know, we hope that we can provide a lot of reasons for patients to come here. We’re not only giving patients state-of-the-art care including a number of exciting clinical trials that are ongoing, but we add to that compassion and also 24/7 access to our doctors on our team. We also have wonderful other members of the team. Our nurses, physician assistant, even our administrators, you know, are just a terrific group and I think we all come to mean a lot to the patients hopefully. This entire team approach and all the members of the team really bring a lot to our patients and giving them this great access. We really try to treat every patient uniquely as we would our own family member or loved one. We emphasize not only length of life that we really fight to extend as much as possible but also quality of life. So, you know, hopefully we just bring all of that to the patients in a unique way.

Melanie:  Thank you so much for joining us today. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.