Electronic link 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.
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."
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.
"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.