A man with a deadly brain tumor that had spread to his back, saw his tumors shrink and, for a time, disappear completely after a new treatment to help his immune system to attack disease — a first in this promising area.
The type of immunotherapy that 50-year-old Richard Grady received already has some people with blood cancers such as leukemia. But the way he got it new, and use it not only for brain tumors, but also other forms of cancer that can spread, such as breast and lung cancer.
Grady was the first person to get the treatment dripped through a tube into a space in the brain where spinal fluid is made, send it to the path of the cancer traveled to his back.
He had “a remarkable response” that opens the door to a broader test, said Dr. Behnam Badie, neurosurgery chief at City of Hope, a cancer center in Duarte, California, where Grady was treated.
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The case is reported in this week’s New England Journal of Medicine.
Each year in the United States, approximately 20,000 people are diagnosed with a form of brain tumor called glioblastoma. Grady, who lives in Seattle, had the usual surgery, radiation and chemotherapy, but the cancer came back.
He is enrolled in a clinical trial at the City of Hope and had some of his own blood cells, called T-cells, removed and genetically modified in the lab to turn them into specialized soldiers to seek and destroy cancer.
The treatment, called CAR T-cell therapy, is used for blood cancers, but the value for solid tumors, is unknown. City of Hope is testing the injection of the cells directly in the brain.
First, Grady had more of an operation for the removal of three of his largest tumors. Then he got six times per week is a infusion of the cells through a tube in his brain, where the largest was. Not cancer again is there, but the other tumors continue to grow, new appeared, and the cancer spread to his spine.
Doctors decided on a bold move: placing a second tube in his brain, in a cavity where spinal fluid is made, and that the cells.
“The idea was to make the flow of the spinal fluid, wear the T-cells at different locations along the route of the cancer had taken Badie, said.
After three treatments, all of the tumors had shrunk dramatically. After the 10th treatment, “we saw all tumors disappear,” and Grady was able to cut down on other medications and get back to work, Badie said.
New tumors, though, have arisen in different places in the brain and the spine, and he is to the radiation. But his response to immunotherapy lasted more than seven months, and “for him to live more than a year and a half after the start of the amazing thing is, for a situation where survival is often measured in weeks, Badie said.
Side effects of the treatment were manageable, such as headaches, fatigue and muscle pain, and some may be the result of other medicines, Grady, need, doctors reported.
The beginning of the study, but it is an advance for the field, “which they showed that it is safe, at least in this patient,” said Dr. Donald O’rourke, a neurosurgeon heading a similar study at the University of Pennsylvania.
O’rourke treated 10 brain tumor patients with CAR-T-cells, but used a single IV dose. A paper detailing the results is in the making, but “it is quite remarkable what we have found,” he said.
In the City of Hope, nine patients have been treated, but until now only three with an infusion in the spinal fluid brain cavity. Two of the nine have not responded to the treatment, Badie said.
His study is supported by the nonprofit Gateway for Cancer Research, the Food and Drug Administration, the California Institute for Regenerative Medicine and the National Institutes of Health. Some authors receive royalties from pending patents or money of Mustang’s Bio, Inc., which has a license from a number of the technology.