Brain surgeons have developed a device the size of a grain of rice they hope could be a breakthrough in treating deadly brain cancers.
The 6mm-long gadget is implanted onto the surface of tumors, where it releases drugs into the masses to shrink or kill them.
When implanted into hard-to-treat brain tumors, the device can deliver multiple different cancer medications all at once. It was trialed on six patients with glioblastomas, the lethal brain cancer that killed President Joe Biden’s son, Joseph (Beau) Biden III, and Senator John McCain.
Most people with a glioblastoma only live 12 to 18 months on average after receiving the diagnosis and only about seven percent are still alive after five years.
The device's development is an answer to the challenge of finding a targeted way to treat cancer within the shortest window of time, given medications can typically only be tried one at a time, making finding the most effective treatment a lengthy process.
A challenge in developing targeted therapies for gliomas in the past is that it can be hard to test multiple combinations of drugs in tumors cells because doctors can only treat patients with one method at a time, representing a significant barrier to treating cancers like gliomas, which combination therapy has shown to be a promising treatment for.
However, this little device could be the solution to this challenge because it can safely administer up to 20 different cancer medications into extremely small areas of a patient's brain tumor all at once during brain surgery.
However, this little device could be the solution to this challenge because it can safely administer up to 20 different cancer medications into extremely small areas of a patient's brain tumor all at once during brain surgery
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While the device was tested on patients with gliomas, researchers believe it could be used on multiple types of brain tumors, signaling a major breakthrough in cancer treatment.
The five-year survival rate for adults with brain cancer ranges from 21 percent to 72 percent.
Dr Pierpaolo Peruzzi, a neurosurgeon at Brigham and Women’s who performed the surgeries said: ‘In order to make the greatest impact on how we treat these tumors, we need to be able to understand, early on, which drug works best for any given patient.
‘The problem is that the tools that are currently available to answer this question are just not good enough.
'So we came up with the idea of making each patient their own lab, by using a device which can directly interrogate the living tumor and give us the information that we need.’
Researchers from Brigham and Women's Hospital in Boston focused their efforts on a type of brain cancer called gliomas, which affects central nervous system cells that protect crucial neurons.
Specifically, researchers aimed to find the best possible way to treat an extremely aggressive form of glioma called glioblastoma, the lethal brain cancer that killed President Joe Biden’s son, Joseph (Beau) Biden III, and Senator John McCain.
Working with six patients, they inserted the tiny rod-shaped devices, which release miniscule doses of anti-tumor medications to highly concentrated areas, into their tumors.
The intratumoral microdevices (IMD) are no longer than six millimeters, roughly the size of a grain of rice or a pencil tip.
Each one contains nine different medications, though it could hold up to 20. One of the drugs loaded into the devices was Temozolomide, a common chemotherapy drug that damages the DNA of cancer cells, preventing them from dividing and growing, eventually killing them off.
The rod-like devices were implanted as part of a standard procedure called resection to remove part or all of the cancerous mass. Dr Peruzzi identified the tumor in each patient and implanted two devices in each one approximately 10 to 15mm apart at the start of surgery.
The IMDs remained in the tumor while Dr Peruzzi worked on surgically removing the mass, giving the microdoses of medicine two to three hours to work within the tumor itself.
Dr Peruzzi said: ‘This is not in the lab, and not in a petri dish. It’s actually in real patients in real time, which gives us a whole new perspective on how these tumors respond to treatment.’
He then removed part of or the entire tumor and the IMDs, which had been infusing parts of the tumor with nine different medicines.
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From there, scientists on the team froze the removed mass with the devices affixed to it and were able to look at how effective they were at delivering concentrated doses of the drugs to extremely specific regions of the tumors.
‘It’s important that we are able to do this in a way that best captures the features of each patient’s tumor and, at the same time, is the least disruptive of the standard of care,’ Dr Peruzzi said.
‘This makes our approach easy to integrate into patients’ treatment and allows its use in real life.’
Their main goals were to determine whether the devices could be safely implanted and whether this type of medical technology could be scaled for use to treat the 15,000 Americans who will be diagnosed with a glioblastoma this year.
Gliomas typically occur in the brain but can sometimes afflict the spinal cord. About a third of all brain tumors are gliomas that originate from glial cells. These cells help support, connect, and protect central nervous system neurons.
Gliomas don’t typically travel outside of the brain, but they are particularly dangerous because they can spread to other tissues within the brain. The most talked-about form of glioma is called glioblastoma.
Brain surgeons classify brain tumor growth on a scale from one to four, with grade 1 tumors growing slowly and appearing the least aggressive, while grade 4 tumors spread rapidly and aggressively. Glioblastomas are automatically grade 4 tumors upon first diagnosis.
The deaths of Beau Biden and Sen McCain in 2015 and 2018, respectively, were both due to highly aggressive glioblastomas. It took less than two years following diagnosis for the glioblastoma to kill Mr Biden, while Sen McCain died just over a year after his diagnosis.
Gliomas are notoriously difficult to treat and chemotherapy, surgery, and other interventions often come up short because of their tentacle-like ability to invade surrounding healthy brain tissue.
The next generation of cancer treatments will increasingly rely on a highly personalized approach that includes tools such as Dr Peruzzi's to speed up the process toward finding the right medicine for each individual patient, optimizing their chance of survival.
Dr Peruzzi said: ‘The ability to bring the lab right to the patient unlocks so much potential in terms of the type of information we can gather, which is new and exciting territory for a disease that has very few options at present.’
