Microdevice Could Revolutionize Brain Cancer Treatment

A new microdevice, which is the shape and size of a grain of rice, could become a game-changer in brain cancer treatment.

The device, designed by researchers from Brigham and Women's Hospital, can help test the effectiveness of a wide variety of treatments in patients with gliomas, a type of tumor that originates in the brain or spinal cord. About 20,000 people in the United States each year are diagnosed with gliomas, one of the deadliest brain cancers that are notoriously difficult to treat.

The device is designed to be used during standard care of surgery. When implanted, it administers tiny doses of up to 20 drugs into extremely small areas of the patient's brain tumor for about two to three hours. The device is then removed during the surgery, and the surrounding tissue is returned to the lab for analysis.

Because the device works while the tumor is still in the body, it allows physicians to assess the effects of drugs on the tumor microenvironment, the cells immediately surrounding cancer cells that can make up almost half the mass of a tumor.

In a phase 1 clinical trial, findings of which were published in Science Translational Medicine, the researchers tested devices on six patients undergoing brain surgery to remove a glioma tumor.

The device caused no adverse effects on patients and allowed researchers to collect valuable biological data, such as how the response changes based on drug concentrations or what molecular changes each drug produces in the cells.

"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," said co-principal investigator and co-corresponding author Pierpaolo Peruzzi, M.D., Ph.D., an assistant professor in the Department of Neurosurgery at Brigham and Women's Hospital.

Researchers hope that the new device can help overcome the challenge of testing many different drug combinations in glioma tumor cells because, currently, it's only possible to treat patients with one approach at a time.

However, the scientists are still working on determining the exact ways the data gathered by the device could be used to optimize brain cancer treatment. They are conducting a two-stage version of their procedure in which patients receive the device through minimally invasive surgery 72 hours before their main surgery.

"We're optimistic that this is a new generation approach for personalized medicine. 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."

- Pierpaolo Peruzzi, M.D., Ph.D

What is glioma?

"Glioma" is a general term used to describe any tumor that arises from the glia, a supportive tissue of the brain that helps to keep the neurons in place and functioning well.

Three types of normal glial cells can produce tumors — astrocytes, oligodendrocytes, and ependymal cells.

• Mixed Glioma, also called Oligoastrocytoma, contains a high proportion of more than one cell type. As the tumor increases pressure inside the brain, the initial symptoms may include headache and nausea. Vision problems and changes in behavior and personality are also associated with the disease.
• Optic Glioma often occurs in children under the age of 10. One in five children with neurofibromatosis (NF-1), a rare genetic disorder, will develop an optic glioma. However, adults with NF-1 typically do not develop this type of tumor. Optic Glioma may cause few or no symptoms, but some patients may experience vision loss, "crossed eyes," and hormonal imbalance, disrupting development.
• Gliomatosis Cerebri is a rare brain tumor that is scattered and widespread, typically involving two or more lobes of the brain. The symptoms of Gliomatosis Cerebri may include personality and behavioral changes and memory disturbance, among others.

The new microdevice that tests drugs in real glioma patients in real-time shows promise in making brain cancer treatment more personalized and effective.