Posted: Jul 17, 2008 12:16 AM
"Senator Kennedy has recovered remarkably quickly from his Monday procedure" and was therefore released a day ahead of schedule, say Kennedy's doctors, who include Lee Schwamm, MD, vice chairman of the neurology department at Massachusetts General Hospital, and Larry Ronan, MD, a primary care physician at the same hospital.
Kennedy will stay at his Cape Cod home "while we await further test results and determine treatment plans. He's feeling well and eager to get started," say Schwamm and Ronan.
Kennedy's brain tumor is a malignant glioma in his left parietal lobe, an area of the brain involved in speech. WebMD spoke with Deborah Heros, MD, associate professor of clinical neurology and neuro-oncology at the University of Miami Leonard M. Miller School of Medicine, about cutting-edge treatments for malignant gliomas.
Heros is not involved in Kennedy's treatment or diagnosis. She notes that the location of Sen. Kennedy's glioma would likely rule out surgery to remove the tumor.
What are the latest or experimental treatments for malignant gliomas, and would Sen. Kennedy be a candidate for them?
The foundation for treatment of a glioma, through the years, has been radiation therapy. Most treatment plans or protocols start with radiation. The oral chemotherapy drug temozolomide (Temodar) has also become part of that initial plan that has been shown to be the most promising treatment. Most treatment begins with that combination of the radiation and the temozolomide.
There are many centers that are looking into newer treatments. Many of them are treatments that either could be added or perhaps used following the radiation and the temozolomide. ...
Some of the newer therapies include more specific chemotherapy agents that we call targeted therapies. We call them targeted therapies because the medication or chemotherapy has been developed to target a specific protein or function of the tumor cell to interfere with the tumor cell growth.
Many people will recognize the name Avastin as being one of the most popular and promising targeted therapies for many kinds of tumors and also gliomas. This targets the tumor's ability to produce new blood vessels, and the tumor needs new blood vessels to grow. The targeted therapy Avastin prevents the tumor from being able to produce new blood vessels. And so, in a sense, the tumor starves itself or cannot continue to grow because it's run out of its blood supply. Some physicians are using Avastin in a clinical protocol with other chemotherapeutic agents and some are using it along with the temozolomide during different phases of the treatment. That could be one add-on that maybe some of the physicians involved in Sen. Kennedy's care are considering.
There are other treatments, including the development of vaccines, or what we call immunotherapy, that are being studied at some of the various centers in the country to try to help the immune system turn around and fight against the tumor cells.
Other treatments being studied -- which I do not believe Sen. Kennedy would be a candidate for -- [include] surgical implantation for delivery of chemotherapy ... into the area of the tumor. Typically, if the patient is not a candidate for surgery because of the [tumor's location in the brain], they probably would not be a candidate for some of these localized treatment options.
Many centers are also using different viruses to deliver different genetic treatments to the tumors.
That's gene therapy?
It's called gene therapy, correct. The treatment uses a virus, and the genetic material within the virus can be manipulated or changed to contain genetic material that might fight directly against the tumor cells. That's a very exciting area. There are some centers around the country that are looking into this type of treatment.
Are there risks if it's a virus? People may hear "virus" and think that sounds risky.
The virus is actually inactivated. Although there might be potential side effects from the overall treatment, the virus itself would not cause a viral infection.
Do you find that a lot of patients with malignant gliomas are looking to get into a clinical trial or looking to try something experimental?
Over the years, a limited number of patients with malignant gliomas have been entered into clinical protocols. Although our treatments have advanced, there certainly is a long way to finding the perfect treatment, and therefore, participation in clinical protocols is very important. With this type of serious tumor, patients are very much interested in participating or at least being aware of what is available around the country to consider participating in a clinical protocol.
How would a patient find out where those trials are being done?
Fortunately, with the help of the media and the help of the Internet and various cancer-related societies, this information is more readily available. There are lists through the National Institutes of Health [and] the American Cancer Society. Many of the specialized cancer support groups throughout the country have lists of centers performing or offering clinical trials. And on the web sites of many of the medical centers -- usually universities but not necessarily limited to universities -- the contact number to inquire about clinical trials and information about clinical trials is available.
Anything else you would want to add?
I think everyone looks forward to seeing Sen. Kennedy move along in his treatment, and I suspect he will be an inspiration to everyone as he begins his treatment.