Study offers hope
to brain cancer patients

By Karen Thomas

Don McHenry went to bed on September 27, 2004 at 11 p.m., just like any other weeknight. The next thing he remembers is waking up in a hospital room at noon the following day with a tube in his throat. He has no recollection of having a seizure in the middle of the night, his wife calling 911, and the paramedics intubating him because he had stopped breathing. In the coming days, after a CT scan and MRI of his brain, he found out that his whole life had changed: the 59-year-old architect was diagnosed with glioblastoma multiforme, a common and aggressive type of brain cancer.

“ I live a really active life, running, cycling, skiing and horseback riding with my family. There was no warning, no real symptoms. And even now, after having surgery, radiation and two rounds of chemotherapy, I am still really well. I know that a positive outlook will help me live my life as fully as I can,” says McHenry, a Calgary resident and father of two. “But I also feel like an innocent man sitting on death row, having been sentenced to death. I don’t know the date, but it’s coming.”

The average life expectancy of people diagnosed with this type of brain cancer is about one year. Findings from a landmark clinical research study, published in the March 10 edition of the renowned New England Journal of Medicine, offer new hope for a longer, healthier life for people with glioblastoma.

Dr. Greg Cairncross, head of clinical neurosciences at the University of Calgary, Calgary Health Region, and colleagues from across Canada and Europe, found that using a novel chemotherapy drug to treat people during and after radiation therapy helped them live longer than using radiation treatments alone. After two years, 10 per cent of people treated with radiation therapy alone were still alive, compared with 26 per cent of people receiving a combination of chemotherapy and radiation.

“ I was beginning to doubt that I would ever see a better treatment for this deadly type of brain cancer,” says Cairncross, a brain cancer neurologist and the Alberta Cancer Foundation Chair in Brain Tumour Research.

“The results of this trial are dramatically improving outcomes for a substantial number of people with this type of brain cancer. Our findings will also open the door to future clinical trials to expand our treatment options,” says Cairncross.

“ This is the first trial to demonstrate that we can truly impact this devastating disease with chemotherapy. This is only a first step toward cure of brain cancer patients and should now fuel interest, continued international collaboration and research to further improve the outcome of these patients,” says Dr. Roger Stupp, lead author and trial initiator from the University Hospital Multidisciplinary Oncology Centre in Lausanne, Switzerland.

The international study, involving nearly 600 people with brain cancer, took place in Switzerland, the Netherlands, Spain, Germany, Italy, France, Poland, Sweden, Slovenia, United Kingdom, Austria, Belgium and Canada. The National Cancer Institute of Canada Clinical Trials Group coordinated Canadian participation in the study. There were more Canadians enrolled in the trial than participants from any other country.

The clinical research team also reported new understanding of a molecular marker known as the MGMT gene. This gene, which is responsible for the repair of certain types of DNA damage, will help cancer specialists predict who will live longer and get the maximum benefit from the new chemotherapy/radiation treatment combination. The international team found that almost half of the patients whose tumours had an inactivated MGMT gene were alive after two years.

“ This new knowledge about the MGMT gene helps us to identify which tumours are sensitive to the treatment we used, and which tumours are more resistant to this treatment,” says Cairncross.

“ This is an extremely important finding because researchers around the world are now working on drugs to target this gene. At the same time, cancer scientists are also developing diagnostic tests that allow us to use the MGMT gene to tailor cancer therapies for each patient, ensure longer life and a better quality of life as well.”

Cairncross, who led the study in Canada, collaborated with colleagues across the country, including Edmonton, Halifax, Hamilton, Kelowna, Kingston, London, Moncton, Montreal, Ottawa, St. John, St. John’s, Surrey, Thunder Bay, Toronto, Vancouver, Victoria, Windsor and Winnipeg. He collaborated in Calgary with Dr. Peter Forsyth, the director of the new Clark H. Smith Integrative Brain Tumour Research Centre, part of the Southern Alberta Cancer Research Institute.

Cairncross is supported by the Alberta Cancer Foundation (ACF), Calgary Health Region, and Cancer Research Society. Forsyth is supported by the National Cancer Institute of Canada, Canadian Institutes of Health Research, ACF, and Kid’s Cancer Care Foundation.