Can Cancer Advances Save Kennedy?

May 22, 2008 — -- When the Wilson family found out that Sen. Ted Kennedy had been diagnosed with brain cancer, they sent him an optimistic note.

"I just wanted him to know that there is some hope," said Marty Wilson, 55, whose mother, Cleora, was diagnosed with brain cancer two years ago. "Though it's not curable, it is treatable."

The note may be a poignant reminder that Kennedy is not alone with his disease. Doctors diagnose about 180,000 new cases of brain cancers each year. Of those, gliomas are the most common type of brain tumor, and malignant gliomas are the most aggressive -- and deadly.

For any patient, such a diagnosis would be devastating and Kennedy has not always had a clean bill of health. Just six months ago, he had surgery to correct a narrowed carotid artery.

At 76 years old, he is also among the older patients with this condition -- which, like many medical conditions, has been known to carry a worse prognosis with increasing age.

Still, cancer experts are not concerned that Kennedy will be precluded from potentially promising new treatments because of his age or his medical history -- which ultimately means that the decision will probably be the senator's when it comes to his course of treatment.

Past Patients May Suggest Promise for Kennedy's Case

Cleora Wilson, 76, has more in common with Kennedy than her age. She also had a malignant glioma and underwent surgery to remove it, followed by radiation and chemotherapy.

But this traditional treatment for brain cancer had limitations. If a surgeon tried to remove a brain tumor completely, the procedure would also remove precious neurons and brain cells that continue to help the body function normally. Radiation and chemotherapy, while they can be effective at killing cancer cells, are also effective at killing healthy cells.

"These drugs are nonspecific poisons," said Dr. Howard Fine, chief of the neuro-oncology branch at the National Cancer Institute, adding that they can be like setting off bombs. "You hope that when the smoke clears that the bad guys are dead and the good ones are still standing."

But the Wilsons refused to settle for just the conventional treatment and the 15-month life sentence the doctors gave Cleora. She chose to receive experimental treatments that would help shrink the tumor and prevent it from growing large again -- and it worked.

Experimental treatments for brain cancer are a promising frontier for patients. Where surgery and radiation stop working effectively, these treatments begin.

Targeted Therapy

Newer, experimental therapies are like smart bombs, Fine said, because they have the potential to target cancer cells and destroy them -- or at least hold them in check -- without destroying other brain cells.

The most promising therapies and those with the best track record are known as small molecule therapies. These treatments involve drugs that inhibit crucial cellular growth processes. Cleora Wilson received Avastin, a drug that prevents her tumor cells from growing blood vessels with which to nourish themselves.

Though Avastin is not yet approved by the Food and Drug Administration for treating brain cancer, it has been approved for treating colon, breast and some types of lung cancer.

Targeted molecular therapies have strong potential for advancement because they can be used for a wide variety of cellular pathways to prevent tumor growth, depending on the person being treated.

"You can have different combinations for different patients and get a more personalized type of treatment," said Dr. Linda Liau, director of the Comprehensive Brain Tumor Program and Neurosurgical Oncology at the University of California at Los Angeles Medical Center.

Immunotherapies and vaccines for brain cancer cells are newer forms of therapy, but experts hope that these will be even more customizable and effective against recurring tumors. These therapies utilize the body's immune response to specifically attack cancer cells.

"The beauty of the vaccine is if you can get the immune system to recognize the tumor, it travels the body and finds infiltrators," said Dr. Andrew Sloan, associate professor of neurological surgery at University Hospitals Case Medical Center. "They basically go on a search and destroy mission. … There is very little toxicity."

Important, since toxicity can often be the limiting factor when deciding how to treat a patient, particularly an older one.

"Sometimes, elderly patients don't receive as aggressive treatments as younger patients," said Dr. Gene Barnett, director of the Brain, Tumor and Neuro-Oncology Center at the Cleveland Clinic. "They have more severe consequences from toxic chemotherapies. … My guess is that Sen. Kennedy is going to get the most aggressive treatment that he can tolerate."

New Frontiers

But in most cases, older patients can handle these aggressive therapies. And they tend to do better when they receive them.

"Unless a patient has a specific medical problem that is a contraindication, age is not a factor," Fine said, adding that given the senator's recent level of job performance, "his status is pretty damn good."

"Most of the therapies we use, both standard and investigative, are very well tolerated," he said.

Also working in Kennedy's favor is the fact that he appears to be free from many of the medical conditions that could cause complications and might bar someone from receiving experimental treatments. These conditions include heart disease, liver problems, Alzheimer's and difficulty speaking or walking.

And newer, targeted treatments mean fewer side effects. In one class of treatment, known as genetic therapies, viruses are used to modify the genetic material in cancerous cells so that they cannot function.

While such therapies represent only a small percentage of new treatments, there are other new strategies as well. Embarking upon them is often a choice the patient must make.

"In general, there are two different types of people," some who are more comfortable with standard care and others who are willing to try new treatments, Fine said. "Both of those patients do the right thing for themselves."