July 19 will mark one year since Arizona Senator John McCain was diagnose with Glioblastoma, an aggressive and deadly form of brain cancer. We’ll talk about McCain’s progress and the type of cancer he has. Dr. Michael Lawton, president and CEO of Barrow Neurological Institute, will tell us more.
Last month we had doctors from TGen give us an overview and treatment update on Glioblastoma which you can watch here.
Ted Simons: IT HAS BEEN A HERE SINCE ARIZONA SENATOR JOHN McCAIN WAS DIAGNOSED WITH GLIOBLASTOMA, AN AGREEIVE AND DEADLY FORM OF BRAIN CANCER. HERE TO TALK ABOUT THIS PARTICULAR CANCER IS DR. MICHAEL LAWTON, PRESIDENT AND CEO OF BARROW NEUROLOGICAL INSTITUTE. WELCOME TO "ARIZONA HORIZON." GOOD TO HAVE YOU HERE.
Michael Lawton: THANK YOU.
Ted Simons: REFRESHER HERE, GLIOBLASTOMA, WHAT ARE WE TALKING ABOUT?
Michael Lawton: SO IT'S A BIG LONG NAME THAT BASICALLY MEANS THE MOST INTRINSIC FORM OF BRAIN TUMORS THAT AFFECT THE CELLS THAT MAKE UP THE BRAIN TISSUE.
Ted Simons: NOT NECESSARILY THINK BRAIN ITSELF. IT’S THE TISSUES SURROUNDING THE BRAIN?
Michael Lawton: THE BRAIN IS COMPOSED OF SUPPORTING CELLS, AND THIS IS A TUMOR THAT ARISES OF THOSE CELLS.
Ted Simons: AND IT DOESN’T REALLY SPREAD TO THE OTHER PARTS OF THE BODY DOES IT?
Michael Lawton: NO BUT IT'S AN INVASIVE TUMOR THAT REALLY DISRUPTS THE FUNCTIONALITY OF THE BRAIN, WHICH IS WHY IT’S SO DEVASTATING.
Ted Simons: AND SYMPTOMS CAN VARY CASE TO CASE.
Michael Lawton: CASE TO CASE, BECAUSE THE LOCATION CAN VARY FROM THE FRONTAL LOBES TO THE EXTERNAL LOBES TO A VARIETY OF PLACES. AND THE SYMPTOMS AND PRESENTATION DEPEND ON WHERE THE TUMOR STRIKES.
Ted Simons: DOES THE SURVIVAL RATE DEPEND ON WHERE IT STRIKES AS WELL?
Michael Lawton: IT CAN. BECAUSE THERE ARE ONLY LIMITED AMOUNTS OF SURGICAL INTERVENTION WE CAN DO, AND OTHER AREAS ARE MUCH MORE TOLERANT. SO WE CAN BE A BIT MORE AGGRESSIVE BUT WITH THIS TUMOR IT'S HARD TO BE CURATIVE.
Ted Simons: YOU JUST MENTIONED SURGERY. OBVIOUSLY SURGERY IS A PART HERE, BUT IS IT EVER POSSIBLE TO REMOVE ALL OF THIS PARTICULAR KIND OF TUMOR?
Michael Lawton: YOU REALLY CAN'T BECAUSE YOU CAN TAKE OUT THE BULK OF THE TUMOR, BUT THIS IS A TUMOR WHO'S CELL MIGRATE FROM THE CORE AND INFILTRATE TO THE SPACES AROUND IT, AND EVEN WHEN YOU THINK YOU HAVE GOTTEN AROUND TO THE END OF THE TUMOR, THERE ARE STILL CELLS AROUND THAT.
Ted Simons: HOW FAST DOES IT RETURN AFTER SURGERY?
Michael Lawton: WELL, IT DEPENDS ON THE TUMOR TYPES, BUT FOR GLIOBLASTOMA, WHICH IS THE MOST DEADLY, THE AVERAGE SURVIVALS ARE 16 MONTHS.
Ted Simons: ALL RIGHT. SO HOW IS IT USUALLY TREATED. WE CAN'T TALK ABOUT SENATOR McCAIN'S CASE OBVIOUSLY, BUT IN GENERAL, HOW DO YOU TREAT THIS? WHAT DO YOU DO?
Michael Lawton: WELL, IT USUALLY BEGINS WITH SURGICAL THERAPY TO DEBULK AS MUCH OF THE TUMOR AS YOU CAN, AND THEN WHEN YOU ARE REDUCED THE VOLUME OF THE TUMOR DOWN TO WHAT IS MANAGEABLE OR SAFE, THEN YOU TREAT WITH OTHER FORMS LIKE RADIATION OR CHEMOTHERAPY. AT THE BARROW NEUROLOGICALINSTITUTE WHERE I WORK, WE TREAT MORE BRAIN TUMORS THAN ANYWHERE IN THE COUNTRY, AND WE HAVE ALL OF THESE DIFFERENT MODALITIES IN PLAY, AND THIS IS REALLY WHAT WE DO. WE TAKE PATIENTS THROUGH THAT PROCESS OF SURGERY, AND THE ADJUNCTTIVE THERAPIES THAT FOLLOW.
Ted Simons: WE HEAR ABOUT IMMUNOTHERAPY IS THAT AN POSSIBILITY HERE?
Michael Lawton: WELL, IMMUNOTHERAPY AND THESE ARE NEWER TYPES OF THERAPIES THAT ARE BEING LOOKED AT IN CLINICAL TRIALS, AND HE CERTAINLY IS PROBABLY ELIGIBLE AND HAS CONSIDERED SOME OF THESE, BUT I DON'T KNOW WHETHER HE ENROLLED IN THESE.
Ted Simons: HOW EFFECTIVE ARE THESE? DO WE KNOW?
Michael Lawton: WE DON'T KNOW. A LOT HAVE THESE HAVE SHOWN PROMISE IN EARLY-STAGE CLINICAL TRIALS OR EXPERIMENTAL MODELS IN ANIMALS BUT HAVE FAILED TO SHOW THE SAME IN HUMANS IN LATER TRIAL.
Ted Simons: I READ SOMETHING ABOUT ALTERNATING CURRENTS APPLIED TO THE SCALP. IS THAT ON A FAR FRINGE OR SOMETHING? WHAT DO YOU KNOW ABOUT THAT?
Michael Lawton: YEAH, I KNOW SOME ABOUT IT, AND AGAIN, BECAUSE THIS IS SUCH A DIFFICULT AND DEVASTATING TUMOR, PEOPLE ARE TRYING -- RESEARCHERS ARE TRYING MANY DIFFERENT THINGS, THAT CURRENT TECHNIQUE IS ONE OF THEM, BUT, AGAIN, LIKE THE OTHERS, UNPROVEN AT THIS POINT.
Ted Simons: WE HAVE HEARD THAT SENATOR McCAIN IS UNDERGOING PHYSICAL THERAPY, WHERE HE IS RECUPERATING AND RESTING. SOMETHING LIKE THIS, PHYSICAL THERAPY WOULD DO WHAT?
Michael Lawton: THE PHYSICAL THERAPY REALLY ISN'T MEANT TO DO ANYTHING FOR THE TUMOR. WHAT WE DO AS NEUROSURGEONS AND NEURONONCOLOGIST ARE AIMED AT FIGHTING THE TUMOR, AND THE THERAPIST DO, THEY HELP DEAL WITH SOME OF THE AFTER EFFECTS OF THE TUMOR THERAPIES.
Ted Simons: THIS IS AGE DEPENDENT BUT CAN YOU CONTINUE SURGERY, CHEMO, RADIATION, OVER AND OVER AGAIN, OR IS THERE A POINT WHERE IT JUST GETS TO BE TOO MUCH.
Michael Lawton: IT GETS TO BE TOO MUCH. MOST PEOPLE GO THROUGH A CYCLE, AND THEN WHEN RETUMOR RECURS IT'S A MUCH MORE MALIGNANT RESISTANT FORM OF THE TUMOR, SO THE EFFICACY OF THE TREATMENT AT THAT STAGE ARE MUCH REDUCED AND IT'S MUCH HARDER AT THAT POINT, BUT ONE OF THE THINGS WE'RE DOING AT BARROW IS TO CONDUCT CLINICAL TRIALS. WE'RE TAKING PATIENTS WHO HAVE GONE THROUGH THE FIRST CYCLE, AND SAMPLING THE TUMORS TO SEE IF THEIR SPECIFIC CELLS ARE RESPONSIVE TO A SPECTRUM OF DRUGS SO WE ARE TAYLOR THE THERAPY FOR THAT PARTICULAR TUMOR TYPE AND THERAPEUTIC AGENT, AND THAT IS HAVING GREAT SUCCESS.
Ted Simons: ARE GENETICS INVOLVED?
Michael Lawton: YES.
Ted Simons: GENETICS SEEMS LIKE IN ALL OF CANCER RESEARCH IT'S HUGE AND GROWING, BUT WITH SOMETHING LIKE THIS, WHAT ARE WE SEEING?
Michael Lawton: WELL, I THINK PROFILING TUMORS WITH THE GENETICS IS REALLY HELPFUL. THIS PHASE ZERO TRIAL IS NOT SO MUCH GENETICS, BUT IT’S A TRIAL AND ERROR, SO YOU EXPOSE CELLS TO A SPECTRUM OF DRUGS, AND YOU CAN GET A QUICK READ ON THE RESULTS FROM AN EARLY SAMPLE. SO A VARIETY OF TECHNIQUES MIGHT BE EFFECTIVE. I THINK OUR APPROACH MAKES MORE SENSE, BECAUSE THE GENETICS STILL ARE A MYSTERY IN MANY WAYS. WE KNOW CERTAIN GENES ARE AFFECTED OR MUTATED IN THIS CANCER. WE DON’T KNOW EXACTLY WHERE THAAT WILL LEAD US.
Ted Simons: SOMETIMES PEOPLE SHOW A GENETIC PROFILE, NOTHING HAPPENS OR IT FULL BLOOMS. YOU NEVER KNOW DO YOU?
Michael Lawton: THAT'S RIGHT.
Ted Simons: YOU HAVE BEEN DOING THIS A LONG TIME, I WOULD IMAGINE.
Michael Lawton: YES.
Ted Simons: ARE YOU ENCOURAGED -- WE DO STORIES ON CANCER RESEARCH A LOT HERE, AND IT JUST SEEMS LIKE THERE IS ALWAYS SOMETHING NEW. IN YOUR TIME PRACTICING, DOES IT SEEM LIKE IT'S MAYBE THE BEST TIME AS FAR AS RESEARCH IS CONCERNED?
Michael Lawton: I THINK IT'S AS GOOD AS MANY. THERE ARE MANY NEW AVENUES THAT ARE BEING EXPLORED NOW. MY SISTER DIED OF A BRAIN TUMOR, AND I JUST KNOW THERE'S ALWAYS AN URGENCY TO FIND THE CURE NOW, BECAUSE WHEN A LOVED ONE IS AFFECTED YOU REALLY FEEL THE PRESSURE OF TIME. SO WE'RE ALL REALLY WORKING HARD, AND THIS IS A WONDERFUL TIME, BECAUSE THERE ARE SO MANY DIFFERENT AVENUES HERE, BUT WE HAVE A LOT OF WORK TO DO, SO THAT'S WHY WE'RE WORKING HARD TO MAKE ADVANCES.
Ted Simons: I'M SORRY TO HEAR ABOUT YOUR LOSS, BUT YOU ARE DOING GREAT WORK, OBVIOUSLY. THANK YOU FOR JOINING US.
Michael Lawton: THANK YOU, TED.
Dr. Michael Lawton: President and CEO, Barrow Neurological Institute
