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Using electrical energy to zap cancer cells may sound like a strange idea. But clinical trials at twelve major hospitals around the country are now testing it against the deadliest form of brain cancer. In this ScienCentral News video, you'll hear from one study participant who a year ago was given only six months to live.


Tumor TreatingFields

Michael Quatrano's head is covered with electrodes and he's tethered to a cable-box-sized electrical device and battery pack -- minor inconveniences after the surgery, radiation and chemotherapy that failed to stop his aggressive brain tumor from growing.

 

Scans of the brain showing tumor location
 
Last August, Quatrano was diagnosed with Glioblastoma Multiforme (GBM), the most common and lethal type of brain cancer. He'd had periodic headaches before, so when he went to the emergency room for what he thought was a migraine, he expected to be treated with pain medication.  

 
 
  "I thought I was going for a regular migraine and they said I had cancer," says Quatrano. "[The surgeon] went in my head and cut it and drained it as much as he could. And he told me that it looked really bad and I had six months to live. Right away, I've had people in my family that's had cancer, so I knew I've got to fight. So I don't give up."

Quatrano had radiation and chemotherapy to shrink the tumor.

"Then what happened, two weeks after I stopped, the tumor grew again," he says."This was like the last alternative. And luckily, it's working out."

 
   
   
 
 
Quatrano's last alternative was entering a clinical trial to test the effectiveness of an unusual new treatment on patients with recurrent GBM. He had a 50-50 chance of being randomly assigned to receive a new noninvasive device that generates electrical fields of a certain strength that, it's hoped, will kill cancer cells but not normal brain tissues.

Neuro-oncologist Herb Engelhard explains it's based on a new finding that cells are most vulnerable to electromagnetic fields when they're dividing.

"Normally in the brain, cells aren't dividing at all-- very infrequently. And cancer cells are dividing very rapidly or very often," he says. "So this treatment focuses on the property of the cancer cells, namely that they are rapidly dividing."

Principal investigator of the arm of the study at the University of Illinois-Chicago Medical Center, one of a dozen U.S. hospitals conducting the trial, Engelhard can't disclose results while the study is ongoing. But, he says, "I've been very pleased with the results that I've seen so far."

Engelhard, a brain surgeon, isn't just an MD. He also has his PhD in tumor biology. "I was skeptical when I first heard about this treatment, I must say that," he says. "But I think you have to keep an open mind about new things, and so I agreed to be one of the investigators in this study.

"We've been very happy to find that there is minimal toxicity-- of course we all know about the possible bad side effects of chemotherapy and radiation therapy," he says. "And so far this new type of treatment has been found to be very safe. And what the study is doing is looking to see whether or not it's effective."

"There's no cutting, there's no drugs involved at all, it's very simple, almost too simple," Engelhard continues.
"We're putting electrodes on someone's head, we're putting an electric field through that, and that electric field is killing cancer cells."

 
 
 
 
  He was impressed by the results of a small safety study, now published in the journal Proceedings of the National Academy of Sciences. "Not only was it found to be safe in the pilot study, it was found that it did improve survival," says Engelhard, who was not involved in any of the device's early studies.

In the pilot study in Europe, researchers led by Yoram Palti of the Technion-Israel Institute of Technology tested their prototype device in ten patients with recurrent GBM. While the purpose of the trial was to look for side effects, the authors compared the subjects' time to progression (how long until their cancer progressed), PFS6 (percent that survive six months with no progression) and overall survival with compiled statistics from clinical trials of the best available treatments for recurrent GBM. The treatment exceeded the historical outcomes in all of these measures, more than doubling the expected survival time on average.

That led the researchers to ask the US Food and Drug Administration to approve a Phase III efficacy trial without first conducting a large Phase II safety trial. Palti, who invented the device, has formed a company called NovoCure that's funding the research.

The Phase III trial, which is still recruiting patients, is a randomized controlled study-- to tell if the device is truly effective, only half of the patients are randomly selected to use the new device. Patients who aren't randomly assigned to the device get the most advanced available treatments.

 

 
Quatrano feels fortunate that he has the device.  

"Ever since I've been in this research I've been doing better, okay? So here we are, I feel good, I don't have all the reactions from chemo and radiation. And it's working out."

Engelhard says new treatments for GBM are badly needed because the disease is so insidious and, in fact, isn't really a tumor at all. "It might show up on the MRI scan as a circle or a ball, but really, by the time it's seen on the MRI scan, individual cells have gone deep into the brain. So glioblastoma multiforme is really cancer of the brain, and it's very, very difficult to treat," he says. "Once the tumor does not respond to radiation therapy and chemotherapy-- because surgery can't remove it all-- then one does have a very short time left on average."

While Englehard acknowledges that the device is "cumbersome," he regards it as a prototype that could be refined if it's proved to work. He also says it's unknown whether it has any long-lasting effects.

Quatrano doesn't care if he needs to wear the device for the rest of his life. His advice to others diagnosed with this vicious opponent?

 

"Fight-- don't believe what they say about the six months and all that because in that time you go through a lot of drama in your head," Quatrano says. "And this thing is okay." 

This research was published in PNAS Early Edition, June 5, 2007 and funded by NovoCure, Ltd.

 
Study Details New Molecular Approach to Preventing Alzheimer's

              

By Ed Edelson
HealthDay Reporter
Thursday, April 24, 2008; 12:00 AM
THURSDAY, April 24 (HealthDay News) -- German researchers are reporting a new approach to the possible prevention of the molecular "debris" that's associated with the development of Alzheimer's disease.
The basic idea -- to block the activity of an enzyme called beta-secretase -- is not new, said study lead author Dr. Kai Simons, a professor of cell biology at the Max Planck Institute of Molecular Cell Biology and Genetics in Dresden.

A number of laboratories, both academic and commercial, are working on methods to prevent the enzyme from slicing a protein into beta amyloid fragments that form the brain plaques found in people with the disease. All work on the same principle. "If we decrease the amount of cleavage, we could in all likelihood reduce the likelihood of the disease," Simons said.

Most experts now agree that formation of the beta amyloid plaques is directly linked to the development of Alzheimer's. The problem with most proposed methods of blocking beta-secretase, Simons said, is that they are designed to work outside of the affected brain cells.

"This process of cleaving takes place inside cells," he said. "We have constructed an inhibitor which binds outside, on the cell membrane, and goes into the cell where the cleavage occurs."

Reporting in the April 25 issue of the journalScience, Simons and his colleagues described both test-tube experiments and animal studies in which the combination of an anchoring molecule and a beta-secretase inhibitor reduced the formation of beta amyloid plaque by more than 50 percent over four hours, while the inhibitor alone was ineffective.

The success is just one small step toward a medically useful preventive therapy for Alzheimer's disease, Simons acknowledged. For one thing, the treatment was given by injection into the brains of the experimental animals (fruit flies and mice), something not likely to be done with people.

"This is proof of principle," Simons said. "The idea would be to get it into the blood in humans and then over the blood-brain barrier into the brain. There are many ways for molecules to get into the brain."

The blood-brain barrier is a network of tightly packed cells that prevents most molecules from entering the brain.

William J. Netzer, an Alzheimer's researcher at the Fisher Center for Alzheimer's Disease Research Foundation at Rockefeller University in New York City, called the new study "a profoundly interesting line of research."

"It is not implausible that one might improve the effectiveness of a drug by coaxing it to go into a region where the enzymes it blocks exist," Netzer said.

But medical use of such a product can raise questions, he said. "When you put an inhibitor into a living being, the chemical you put in can be modified in the body. Where a compound goes into a cell is a complicated issue when you put it into a human being," he added.

Dr. James Galvin, associate professor of neurology and psychiatry at Washington University in St. Louis, called the German research "a novel idea."

If the concept works, it would solve a puzzle about how to best target the enzyme, Galvin said. And it is a concept with broader medical possibilities, he said.

"You can potentially inhibit other enzymes where cleavage occurs within membranes," he said.

There are new ways to stop  any side effects, to give less IVIg and get better results based on cutting edge research by CIDPUSA. That is by using  subcutaneous IVIg.

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           IVIg is a collection of antibodies called IgG.

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