Pearls From: Alfredo Quinones, MD

— Harnessing electromagnetism and immune cells to treat brain cancer


What's coming down the pike in brain cancer treatment? In this exclusive MedPage Today video, Alfredo Quinones, MD, chair of neurosurgery at the Mayo Clinic in Jacksonville, Fla., discusses checkpoint inhibitors, immunotherapy, and cellular therapy as potential candidates. He also assesses an FDA-approved device that uses electromagnetism to fight cell proliferation.

A transcript of his remarks follows.

The standard of care for brain tumor surgery presently involves first making sure that the patient has a preoperative imaging study, which means an MRI that tells you the anatomy of the lesion. We then go ahead and take the patient many times for a surgical resection ... and then we decide whether or not the patient is going to require radiation and chemotherapy if the lesion happens to be a glioma versus a more benign type of lesion like a meningioma or a pituitary tumor.

If the patient happens to have a malignant tumor like a glioblastoma multiforme (GBM), the patient is going to require radiation and chemotherapy. The radiation happens daily, five days a week, for six weeks for a total of 30 treatments. The chemotherapy involves simultaneously taking a drug that is called temozolomide, or Temodar, and they take it every day by pill, and once a week most of the patients get their laboratory values to make sure that their blood levels are stable and that this chemotherapy is not causing any problems with their blood count.

Some of the most interesting developments on the horizon include things that are actually already here. For instance, the use of electromagnetic fields to be able to stop cells from migrating and dividing in the brain. This requires that patients put on a helmet, then this helmet has magnetic fields that are being produced through a battery that they carry themselves. These electromagnetic fields stop cells from migrating and dividing, and as of last year this was approved by the FDA in the United States for the treatment of brain cancer. These are things that are already here.

Now, the things that we are beginning to look for on the horizon include things like checkpoint inhibitors. These are specific drugs that can really hone into parts of the cell that makes it very dangerous and proliferative. The next is using your own immune system to fight brain cancer, and finally the use of cellular therapy such as stem cells, either neural stem cells or mesenchymal stem cells that we can get from the bone marrow or from fat.

We are in the process, thanks to the research from many people around the world, of using the cellular therapy as a Trojan horse that we can load with treatment, put it back in our patients and these cells find their way all the way up to these malignant cancer cells and deliver a cargo. These are the things that we were going to see most likely over the next decade playing a very important role in helping our patients with brain cancer.