MIAMI
— When U.S. Sen. Edward Kennedy was diagnosed with a
glioblastoma of the brain in May 2009, doctors understood
there was little chance he could survive it. He died that
August.
"That’s
a malignant tumor. The current five-year survival rate is 1
percent," says Ricardo Komotar, a neurooncologist at
Sylvester Comprehensive Cancer Center.
But
cancer specialists from the University of Miami Medical School
and nine other U.S. institutions are well into clinical
experiments aimed at ending the tumor’s fatal reputation.
"We’re
not going to cure it," says Komotar, who is also director
of surgical neurooncology at University of Miami Hospital.
"Our goal is to convert it into a chronic condition like
high blood pressure or diabetes that you can live the rest of
your life with and live a very normal life."
Their
weapon: a brain cancer vaccine. It’s not a preventive
vaccine like a flu or polio shot, given to ward off disease.
Instead, it’s a "therapeutic" vaccine given after
the patient already has the tumor. It’s still called a
vaccine because, unlike most cancer medicines, it doesn’t
attack the disease directly. Instead, it marshals the body’s
own immune system to attack it.
"This
is the future of cancer therapy," Komotar says.
"Radiation and chemotherapy fight the cancer but they
also kill normal cells, and they’re toxic. This kills the
cancer without harming normal tissue."
Sheryl
Shetsky, president of the Florida Brain Tumor Association,
said the research is important because "glioblastomas are
30 percent of all brain tumors, and they’re the most
devastating tumor. You’re still going to want radiation and
chemo for other cells you can’t see. But this can buy the
patient a lot more time."
The new
vaccine is given quickly after a patient’s glioblastoma is
diagnosed, Komotar says, because doctors need to use the
excised tumor to make the vaccine.
In the
treatment, surgeons remove the malignant tumor, then isolate
and concentrate essential proteins from it and inject them
back into the patient’s arm six to eight weeks later. The
patient’s immune system recognizes the proteins as invaders,
and produces billions of T-cells, its natural attack system,
to fight it.
"It
really sparks the immune system; it gives it a target,"
Komotar says. "Lots of work remains to be done, but it is
a step in the right direction."
Developed
about five years ago at the University of California at San
Francisco, the vaccine did so well in Phase I clinical trials
for safety that it now has U.S Food and Drug Administration
approval to begin Phase II trials for efficacy.
Even in
the Phase I trials, it greatly extended the life expectancy of
volunteers, Komotar says.
Phase II
is a multicenter trial with hundreds of patients at 10
institutions including the University of Miami, University of
California at San Francisco, Mayo Clinic, Columbia University,
University of Pennsylvania, Northwestern, Yale and Case
Western.
If this
phase is successful, Phase III would involve many more
patients and could result in final FDA approval in three or
four years, Komotar says.
The
University of Miami has begun recruiting volunteers for the
study. A patient must have been diagnosed by MRI with a
glioblastoma, but must not have started surgery, chemotherapy
or radiation. That’s because study surgeons must remove an
intact tumor to use in creating the vaccine. To volunteer,
call Komotar at 305-689-2427 or 917-617-2140 or at rkomotar@med.miami.edu.