On average, 213 primary brain tumours are identified annually. Research may aid their treatment, writes Kirstin Goldring
Patients with invasive brain tumours often face a poor outcome despite new surgical treatments. However, new research in Dublin aims to improve the outlook for these patients by developing personalised treatments devised on a patient-by-patient basis.
The goal is to target specific drugs to those individuals who will benefit most from them, explains Dr Verena Amberger-Murphy from the National Institute for Cellular Biotechnology (NCIB) at Dublin City University. Each patient will be assessed so they can be given an individual therapy plan.
On average, 213 primary brain tumour are identified in Ireland every year, she says. Unfortunately, chemotherapy and radiotherapy are largely ineffective due to the resistance of these types of tumours. More than 50 per cent of all brain tumours are termed gliomas. The name derives from the glial cell, a supporting cell within the brain from which they arise. They are graded one to four, based on how quickly they will develop. Grade four are most malignant and develop very fast.
"There is currently no successful treatment for the most malignant grade three and four gliomas," says Murphy. For the past 30 years, patients have been treated in the same way and the latest chemotherapy drug only improves prognosis by a couple of months, she says.
Cancer Research Ireland, the research division of the Irish Cancer Society, is investing more than €196,000 in a three-year research project proposed by Murphy. The project aims to identify a group of patients with these most malignant tumours, who are more likely to respond to a group of drugs known as tyrosine kinase inhibitors (TKIs).
"TKIs are a new group of drugs, not around 10 years ago, that are incredibly effective," says Dr Patrick Corley, cancer research officer in the Irish Cancer Society. These drugs are already being used to treat certain gastrointestinal tumours and chronic myeloid leukaemia.
Murphy's work was sparked by a clinical trial in the US, where a cohort of patients with gliomas was treated with TKIs. "Twenty per cent of patients responded very well, although the rest did not respond at all," she says. For this reason the trial was not seen as successful.
Murphy, however, thinks the information from the trial is very interesting. Her research aims to identify characteristics or markers present in the group of patients that could be used to develop a tool for the neuropathologist.
"Our long-term goal is to set up a test system for the neuropathologist, so that he/she can make the decision from the biopsy as to whether the patient will benefit from TKI drugs or not," explains Murphy.
She is working closely with neuropathologist, Dr Michael Farrell at the Beaumont Hospital, Dublin. A tissue biopsy is taken in theatre at the Beaumont for diagnosis. With the patient's consent after the diagnosis has been made, the rest of the tissue can be divided for research. A PhD student at Beaumont characterises some of the tissue by identifying whether it contains certain markers. The rest is used by NICB, where they culture the tumour cells to produce more for testing.
Cancer cells are tested to discover how they respond to the TKI drugs. Murphy can investigate whether certain concentrations of the drugs kill the cells, stop them growing or affect their invasiveness/migratory action.
Initial results look promising and Murphy is optimistic about the use of TKIs particularly as the side-effects are minimal.
"Verena's work is extremely exciting," says Dr Corley. "It is important for patients here in Ireland to know, if they are generous enough to participate and allow samples to be used for research, they could help future development of treatments."