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procedure involves inserting a probe directly into the tumor, where thermal heat destroys it. Heat levels are monitored in real time in the BrainSuite. Claudio Tatsui, M.D., associate professor of Neurosurgery, is the first in the world to use this technique for metastatic spinal tumors. MD Anderson spine tumor patients are also benefiting from a recently opened multidisciplinary spine tumor clinic, which allows patients to see all of their key providers – including rehabilitation, pain medicine, neurosurgery and radiation oncology – on the same day in the Brain and Spine Center. The clinic was opened in 2018 in coordination with the launch of an Enhanced Recovery After Surgery (ERAS) program for spine tumor patients. The goal of this program is to take steps before surgery to ensure shorter hospital stays, decreased pain and a quicker return to normal after surgery. Navigated transcranial magnetic stimulation (nTMS) is a relatively new technology for pre-surgical planning that identifies functional boundaries of brain tumors. The non-invasive system allows the surgeon to map brain functionality in an outpatient setting prior to surgery. Sujit Prabhu, M.D., professor of Neurosurgery, has shown nTMS is a safe and useful tool to identify and preserve both motor and speech function. The Neurosurgery team has also played a key role in developing a brain metastasis clinic at MD Anderson, which opened in 2019. In this multidisciplinary clinic, patients with brain metastases receive coordinated care from a medical oncologist specialized in their primary cancer type, a radiation oncologist specialized in brain metastases, a neuro-oncologist and neurosurgeon, all in a single visit. Bringing hope to glioblastoma patients Glioblastoma is the most common malignant primary brain tumor in adults. This highly aggressive cancer is diagnosed in 15,000 patients each year. Only 5% to 10% are alive five years after diagnosis. The Neurosurgery department has been at the forefront of collaborative initiatives designed to bring clinicians, translational researchers and basic scientists together to improve the five-year survival of glioblastoma. These initiatives include MD Anderson’s Brain Tumor Research Program, Glioblastoma Moon Shot™ Program and Specialized Program of Research Excellence (SPORE) grant for brain cancer research. “We believe that working together with all disciplines that play a role in brain tumor patient care and research is the only way to make progress for our patients,” Lang says. One of the newest examples of this type of collaborative work is the introduction of the Glioma Longitudinal AnalySiS (GLASS) Consortium as a new project within the Glioblastoma Moon Shot. The consortium is composed of neuropathologists, clinicians, scientists and bioinformaticians from leading institutions across the globe. MD Anderson has taken on a leadership role in the consortium in order to accomplish a major goal of the Glioblastoma Moon Shot: understanding the molecular evolution of gliomas that cause these tumors to become increasingly resistant to therapy. The project will involve gathering paired samples of primary and recurrent tumors during surgery, along with other treatment and outcomes data, for comprehensive analysis. Neurosurgery faculty members are also leading a number of clinical trials, including two that were developed from bench to bedside at MD Anderson: Delta-24-RGD, a modified cold virus that destroys gliomas without harming healthy brain tissue, was engineered at MD Anderson by Juan Fueyo, M.D., professor of Neuro-Oncology. Developing and optimizing this viral therapy has been a major project of both the Brain Cancer SPORE and Glioblastoma Moon Shot. Results of the Phase I clinical trial led by Lang were published in Journal of Clinical Oncology in 2017 and showed tumor reduction in 72% of patients. Three patients had a complete response, with no recurrence for more than three years. The study also showed an immune reaction to the tumor following the viral infection, with strong T-cell infiltration. Based on these findings, Lang and his team are participating in a multicenter Phase II clinical trial of Delta24-RDG and pembrolizumab, a checkpoint inhibitor. While pembrolizumab has not been successful on its own against glioblastoma, investigators anticipate it will produce a better response when combined with the immune reaction triggered by the virus. Patient enrollment for this nationwide trial is expected to continue through 2019. Currently, the virus is injected directly into the tumor, which isn’t a reliably effective delivery method. To combat this challenge, Lang’s team has received FDA approval for a Phase I clinical trial to test delivery of the virus via human mesenchymal stem cells derived from the patient’s own bone marrow. These cells are capable of targeting the tumor after being injected into the bloodstream. The trial began in 2019. WP1066 was also created at MD Anderson and entered a Phase I clinical trial in 2018. MD Anderson chemist Waldemar Priebe, Ph.D., and neuro-oncologist Charles Conrad, M.D., modeled this novel STAT3 inhibitor after a natural compound that’s able to cross the bloodbrain barrier. The laboratory of Amy Heimberger, M.D., professor of Neurosurgery, showed WP1066 prevents tumors from using the STAT3 pathway to evade the immune system and can
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