New brain cancer treatment extends survival for more patients

Patients stay home, take a pill instead of IV chemotherapy

A doctor at the James P. Wilmot Cancer Center has developed a new brain cancer treatment that, in a pilot study, shows promise at keeping more patients alive longer than the best current standard treatments for the disease. Preliminary findings were presented recently at the American Society of Clinical Oncology annual meeting in Chicago, and now the study is continuing for adults and will be expanded to include children nationwide.

The treatment is a combination of two cancer-killing drugs that can be taken orally as pills, making it easier on those patients who have already undergone difficult surgery, radiation or traditional, intravenous chemotherapy.

“It’s not a miracle, but it’s a piece of the struggle against brain cancer,” says David N. Korones, M.D., principal investigator and associate professor of Pediatrics, Oncology, and Neurology at the University of Rochester Medical Center. “It’s a new, somewhat innovative approach that has merit and offers better tolerance than traditional chemotherapy. It makes life much easier for these patients. Patients can stay home and simply take a pill, instead of coming into the hospital for several hours to be tethered to an IV.”

Korones is the first to investigate the effectiveness of temozolomide and etoposide, given together for patients with recurrent malignant glioma, the most common brain tumor in adults. Each of the drugs, which have been approved by the Food and Drug Administration, has been used separately with some success. But Korones noticed that laboratory data showed synergies between the two medications, and he theorized they may work better in tandem.

Among the 24 adult patients he has followed so far, 16 percent saw their tumors shrink and 35 percent were stable with no disease progression after six months, compared to 10-20 percent of patients who stabilize after traditional chemotherapy. The results are encouraging, he says; the median survival time for brain cancer that recurs is just six months.

The medications have been reasonably well tolerated. With no need to come into the hospital for IV therapy, patients can stay home and report weekly for blood tests. In a pilot study of four children aged 10 or older, using doses comparable to the adults, Korones also noted that side effects were minimal, and the tumors shrunk dramatically.

Brain cancer consists of a mass of cells that do not belong there. But for cancer-fighting drugs to reach the mass, first they must be able to pass through the blood-brain barrier, which is cleverly designed to keep out toxins. Temozolomide and etoposide are effective at passing through the barrier, Korones says.

Schering-Plough Inc., manufacturer of temozolomide, is funding the research. With Korones as the principal investigator, other institutions participating are: Rochester General Hospital’s Lipson Cancer and Blood Center; Roswell Park Cancer Institute, Buffalo; Dent Neurologic Institute, Buffalo; SUNY Health Science Center, Syracuse; The Brain Tumor Center at Duke University Medical Center, Durham, N.C.