Stuart’s glioma tumour was discovered in his frontal lobe during a routine scan in 2008 (Image: Courtesy of Stuart Farrimond)

ONE day, perhaps in the next five years, I will develop a malignant brain tumour called a glioblastoma that could take just 15 months to kill me.

As a former practising doctor, I know that these tumours are some of the hardest to treat – which is why this short prognosis has remained largely unchanged for the last decade.

But radical thinking is starting to yield results. For example, an innovative “anti-cancer hat” has been so successful that trials have been cut short to allow more people to benefit from this approach as quickly as possible. Other unconventional treatments are also moving forward in trials.


The tumour is clearly visible in the frontal lobe (Image: Courtesy of Stuart Farrimond)

My medical career ended the day I was diagnosed with a glioma brain tumour, back in 2008. While it was surgically removed several days later, the cancerous growth had already seeded my brain with microscopic deposits, which will help it to return as an angrier and more aggressive glioblastoma. In 2008, I was given a 50 per cent chance of making it to 2020, but who knows – one of these new options could help me live longer.

Nanotherapy

When a tumour is buried deep within the brain, removing it risks causing brain damage. Nanotechnology offers a safer alternative. A technique dubbed Nanotherm involves injecting tiny metallic spheres – just 12 nanometres across – into tumours. When agitated using a strong alternating magnetic field, these spheres heat up to 80 °C – enough to cook and cauterise a tumour from the inside.

Created by a team at German firm MagForce, this approach is being tested as a method to boost the power of chemotherapy and radiotherapy for treating glioblastoma brain tumours. Early trials have been a success, and MagForce’s Hoda Tawfik says that some recipients have lived for nine years after diagnosis. Larger trials are now under way to find out just what part Nanotherm can play alongside existing treatments.

A potential cure for me? Tawfik hedges her bets, explaining that this treatment will work best alongside others. “We do not have a cure,” she says, but adds that their work so far can “offer hope of long-term survival”.

Anti-cancer hat

In November, Roger Stupp at the University of Zurich in Switzerland proclaimed the birth of “a new standard of care for patients suffering from glioblastoma”. Speaking in Miami, he was describing an anti-cancer hat, or the NovoTTF-100A to give it its official name.

Too sci-fi for some (Image: Novocure)

Twenty years in development, the NovoTTF-100A doesn’t have the pipes and metalwork I would expect from a cancer-killing machine. It’s more like the sort of thing Apple would design – a white skull cap attached to a battery pack (see photo).

It is designed for people with glioblastoma to wear for 18 hours a day, while military-grade ceramic transducers within the hat pulse alternating electrical fields into the brain. These fields interfere with the protein framework that’s essential for cell division, preventing the replication of malignant tumour cells, which divide far more often than healthy adult cells.

An ongoing trial of 315 people receiving chemotherapy while wearing the device has found that they are 50 per cent more likely to be alive two years after diagnosis than those receiving standard treatments. These mid-trial results were so impressive that the test is due to end early so that more people can use the device as soon as possible.

David Stocker, from the device’s manufacturer Novocure Europe, says the hat has been too much like science fiction for some, who believe the use of electric fields in medicine has more to do with quackery than science. “Many researchers and academics have a hard time understanding how the system works,” he says. “It is only now that we have the trial results to show beyond any doubt that it does actually work.”

The NovoTTF-100A is no silver bullet though – it usually only adds months to life, effectively slowing but not killing the cancer, although some users have gone on to live for more than 10 years. I would be interested to know if it could be used for people like me, whose tumours have not yet progressed to a highly aggressive glioblastoma. And while the idea of killing cancer while I shop is appealing, the eye-watering cost of £17,000 a month is less so.

Personalised vaccine

A cheaper alternative might be a personalised vaccine called DCVax. Developed by NorthWest Biotherapeutics in Bethesda, Maryland, this approach uses a person’s own immune system to attack their cancer.

Cancer vaccines have been tried before, but virtually all have failed. Linda Powers of NorthWest Biotherapeutics says most existing attempts are “trying to rehabilitate immune cells that have already been hobbled by the cancer”. Her firm’s solution is to rekindle a person’s exhausted immune system by growing new white blood cells for them.

The idea is that bone marrow cells that haven’t yet matured into immune cells are extracted from a person’s blood and nurtured in the lab into dendritic cells – the army generals that organise the rest of the brain’s immune system. Exposing these cells to biomarkers from the person’s tumour primes them to seek and destroy that particular cancer. The finished batch of activated, educated immune cells are then injected into the person’s blood to do their work.

And it is so far so good in early trials. One trial had an average survival of around three years, and in some tests, a few individuals have gone on to survive more than 10 years – that’s eight times the average of 15 months.

Applying this technique to an earlier stage glioma like mine might perhaps prevent it from mutating into a glioblastoma. And because it would be my immune system doing the work, there are likely to be relatively few side effects. For now I’m crossing my fingers – randomised trials for people with glioblastoma are now recruiting with early results expected later this year.

Gene therapy

Meanwhile, Dror Harats of Israel-based VBL Therapeutics thinks he may have devised a gene therapy technique that could change my future. His strategy hits cancer cells’ ability to divide by targeting their blood supply and starving them of the fuel they need.

As a tumour grows, it releases chemical messengers that trigger new blood vessels to grow toward it, feeding its voracious appetite for oxygen and nutrients. Through 20 years of research, Harats discovered that the cells lining these newly forming capillaries have unique genetic features that can be exploited. His team has genetically engineered harmless adenoviruses to infect the capillaries’ cells and insert a gene that triggers them to self-destruct.

In early human trials, this experimental treatment, called VB-111, has fared remarkably well, apart from some flu-like symptoms. When tested on 46 people with glioblastoma for whom all other treatments had failed, those who received repeated injections of virus particles alongside standard drugs survived for 18 months – much higher than the average life expectancy for such patients, of around six months.

If these numbers hold up under repeated testing then VB-111 will be a landmark breakthrough, offering a longer, better quality of life. It wouldn’t work for me yet, but could be an option once my tumour becomes a glioblastoma. But speaking personally and not as a doctor, I confess I have some irrational hang-ups about a genetically engineered virus coursing through my blood.

Eyeing my options

Stuart Farrimond: a personal interest (Image: James Green)

As a doctor, I am encouraged that these treatments offer serious potential – and as a patient, I’m excited by what they could offer me. I would snatch anyone’s hand off to get a nanoparticle injection instead of an operation, and the anti-cancer hat could well treat my tumour while I live a normal life, walking the dog or doing the shopping. Although none would count as a cure, each of these treatments boasts a handful of long-term survivors, and over the next five to 10 years, it is possible that combined therapies could turn this terminal condition into a controllable one.

I would snatch anyone’s hand off to get a nanoparticle injection instead of an operation

Leader: “It’s time to take drug trial participation seriously“

This article appeared in print under the headline “My brain tumour, my options”