The name of Senator John McCain’s newly diagnosed tumor will sound grimly familiar to residents of Massachusetts: glioblastoma, the deadly brain cancer that killed Senator Edward M. Kennedy in 2009.
But nearly a decade after Kennedy became ill, does McCain face a brighter prognosis?
In interviews with the Globe, four doctors who specialize in brain cancers — including two who were involved with Kennedy’s care — emphasized that glioblastoma remains incurable but expressed hope about treatments on the horizon.
“The difference now versus then is that we’re much more cautiously optimistic,” said Dr. Mitchel S. Berger, professor and chairman of the Department of Neurological Surgery at the University of California, San Francisco. Berger was a member of a team of doctors that Kennedy consulted after his diagnosis.
Although the standard treatments haven’t changed since Kennedy’s time, refinements in surgery, radiation, and chemotherapy over the years have made them more effective, Berger said.
“We have a lot more things to throw at it and we understand the disease much better,” he said. “We’re hopeful we’re going to see strides in the overall outcomes of these patients.”
So far, however, it’s been more like baby steps. With treatment, patients with glioblastoma typically survive 15 to 18 months after diagnosis. That’s three months longer than a decade ago, when Kennedy was diagnosed.
But a fifth to a quarter of patients live three to five years or longer, more than in the past, Berger said.
On Thursday, as the world was abuzz over McCain’s diagnosis, Dr. William T. Curry, director of neurosurgical oncology at Massachusetts General Hospital, met with a patient who was first diagnosed with glioblastoma nine and a half years ago. “He never missed more than two days of work,” said Curry, a professor of neurosurgery at Harvard Medical School.
Such patients are rare, he said. “I would consider them outliers. We’re seeing them a little bit more but not often enough.”
Glioblastoma, the most common brain cancer, with 13,000 new cases each year in the United States, remains one the most challenging cancers that doctors confront. It arises from the cells of the brain, attacking the organ that makes people who they are. And the blood-brain barrier, a membrane that prevents substances in the bloodstream from reaching the brain, makes it difficult to deliver anti-cancer medications.
This cancer is also wily and nimble, seeding the brain with microscopic malignancies, hiding from the immune system, and mutating quickly to resist the effects of medications. The tumor is genetically different from person to person, and also changes within each individual, a perpertually moving target.
As result, treatment works, but only for awhile — until the cancer outsmarts it.
“It is a very, very serious illness and has a poor prognosis still,” said Dr. Alexandra Golby, director of image-guided neurosurgery at Brigham and Women’s Hospital and a Harvard professor of neurosurgery.
The protocol for treating glioblastoma, in its basic outlines, has remained unchanged for a decade, Golby said. Patients first undergo surgery to remove as much malignant tissue as possible. Then they get six weeks of radiation along with a drug that makes the brain more responsive to radiation. After a month’s break from treatment, patients get chemotherapy five days a month.
How well people can function during treatment depends on their age and overall health at the outset, and where the initial tumor was located, Golby said. Many can work during treatment. But if the tumor damaged parts of the brain affecting thinking, speech, or movement, people will have a harder time tolerating the treatment.
McCain may be lucky in that respect, said Dr. David A. Reardon, clinical director of the Dana-Farber Cancer Institute’s Center for Neuro-Oncology. Although not involved in McCain’s care, he said public reports of his treatment indicate that the surgery took place in a part of the brain unlikely to suffer noticeable damage from the tumor. Reports indicate the tumor was successfully removed, although the cancer is likely to return eventually.
As a result, Reardon said, McCain may be able to return to the Senate and resume a degree of normal activities for a time. “He has to be careful not to push himself,” Reardon added.
Reardon was part of an extensive team involved in Kennedy’s care in 2008 after he received surgery at Duke University’s Brain Tumor Center, where Reardon was associate deputy director at the time. Kennedy’s surgery “had a significant impact in improving his outcome,” Reardon said. A few weeks later, Kennedy was able to make a dramatic visit to the Senate to cast a vote on health care.
McCain, who is 80, may benefit from advances in immunotherapy and new understanding of the genetic makeup of individual tumors, Reardon said, although these new therapies are still experimental.
“There’s been remarkable advances, in particular in understanding the biology of this type of cancer,” he said. “Based on that research, we are now moving forward developing therapies.”
Two avenues of research are especially promising: immunotherapy — drugs and vaccines that teach the immune system to attack the tumor; and precision medicine — analyzing the genetics of each tumor to ascertain which drugs will be most effective in combatting it.
For Kennedy — who died at age 77 on Aug. 25, 2009, 15 months after his diagnosis — these new therapies were not sufficiently developed to provide any help.
Kennedy’s son, former US Representative Patrick J. Kennedy, offered his thoughts in a tweet Thursday: “Sen. McCain, you were there for my dad when he had a brain tumor. All of America is here for you now—especially me and my family.”