Brain cancer vaccine trial offers 'glimmer of hope'
By REBECCA PALMER - The Dominion Post | Monday, 25 August 2008
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Its name is an unfamiliar mouthful and it is not one of "big cancers".
But glioblastoma multiforme is the most common and aggressive primary
brain tumour - and there's no cure.
"Despite intense efforts, there's really been little progress made over
the last few decades in terms of outcome," says Wellington Hospital
neurosurgeon Martin Hunn.
"Even with the best treatment we have, which is a combination of
surgery, radiotherapy and chemotherapy, the median survival is only 15
months."
Mr Hunn and scientists at Wellington's Malaghan Institute of Medical
Research hope a vaccine - tailor-made from a combination of a
specialised group of cells and the patient's own tumour - can help at
least some patients. They are preparing to start a phase 1 clinical
trial to test the feasibility and safety of the new therapy.
Glioblastoma multiforme is a fast-growing tumour that forms from glial
(supportive) tissue of the brain and spinal cord. It usually spreads
quickly to other parts of the brain.
Kapiti man Dave Bowman, a former policeman, was among those whose lives
it has claimed. He died in 2006 aged 36. He spent much of his illness
campaigning for government funding for brain tumour chemotherapy drug
temozolomide - known in New Zealand as Temodal. He and wife Penny paid
tens of thousands of dollars for the drug, with the help of community
fundraising.
A few months before his death, Pharmac agreed to fund it for patients
with newly diagnosed aggressive brain tumours.
Penny describes glioblastoma multiforme as a particularly cruel cancer.
"The problem is, it's in your head and it's not like you can chop it
off. That's what makes it so hard to deal with. You can't get away from
it."
Two years after Dave's death, she continues to run an online support
group for people affected by brain tumours.
Mr Hunn says Wellington Hospital treats about 35 new patients a year.
Though it is "not one of the big cancers", it affects people "in the
prime of their life".
The researchers plan to recruit at least 12 patients whose tumour has
come back. "It's at that point we will come in and try something
unique."
Patients will be treated with a vaccine made from dendritic cells,
which are responsible for initiating immune system responses. When they
are working properly, dendritic cells can activate T-cells to destroy
cancerous tissue. But in cancer patients, dendritic cells often do not
work the way they should.
In the vaccine, functioning dendritic cells will be isolated from a
patient's blood, then "loaded" with tumour remnants, before being given
back to the patient.
Mr Hunn says that, so far, dendritic cell vaccines have shown modest
benefits. "On its own, in its current form, it's not the big
breakthrough we're looking for."
What will be different about this trial is that it will combine the
vaccine with treatment using temozolomide.
Mr Hunn says other trials have already shown the vaccines are safe on
their own.
"And we know what chemotherapy does to people. What we don't know is
what might happen if we combine the two treatments.
"Because this hasn't been done before, we don't actually know whether
this can be done. We don't know if it's a feasible treatment for the
patients."
Malaghan Institute vaccine research group head Ian Hermans says the
researchers will recruit patients who have previously been treated for
a tumour, which has returned. Once they have had surgery to remove the
recurring tumour, tissue from it will be used to help develop a
vaccine.
They will be given several courses of the vaccine, while also being
treated with temozolomide.
Scientists have been working on dendritic cell vaccines for quite a
while, Dr Hermans says.
"It's fair to say that there is a lot more to understand about how
these vaccinations work. I'm confident that we can get them to be a lot
more efficacious in the future based on the basic research we're doing
in the lab."
He believes the real advantage of the therapy will be seen when it is
combined with chemotherapy.
The study is among Malaghan Institute cancer research that has received
$1 million from the Cancer Society - funding Dr Hermans and Mr Hunn are
grateful for.
Penny Bowman says: "To have a glimmer of hope would be fantastic for
people, because you need that."
The Cancer Society's annual fundraising Daffodil Day is this Friday.