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For kids with one type of deadly brain cancer, an unusual treatment shows promise

The study used genetically modified herpes virus to treat gliomas, which account for 8% to 10% of childhood brain tumors and often return after surgery, chemo or radiation.

This 2016 photo shows Jake Kestler (center) with his parents Gallite and Josh and sister Lily a month before he was diagnosed with a brain tumor called a glioma. Jake received a genetically modified type of herpes virus as an experimental treatment for the cancer when he was 12. “He lived for a year and four months after that,” long enough to celebrate his bar mitzvah, go with his family to Hawaii and see a brother be born, Josh Kestler said.
This 2016 photo shows Jake Kestler (center) with his parents Gallite and Josh and sister Lily a month before he was diagnosed with a brain tumor called a glioma. Jake received a genetically modified type of herpes virus as an experimental treatment for the cancer when he was 12. “He lived for a year and four months after that,” long enough to celebrate his bar mitzvah, go with his family to Hawaii and see a brother be born, Josh Kestler said.
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For decades, a deadly type of childhood cancer called glioma has eluded science’s best tools. Now, doctors have made progress with an unusual treatment: Dripping millions of copies of a virus directly into kids’ brains to infect their tumors and spur an immune system attack.

A dozen children treated this way lived more than twice as long as similar patients have in the past, doctors reported at an American Association for Cancer Research conference and in the New England Journal of Medicine.

Though most of the children ultimately died of their disease, a few are alive and well several years after treatment — something virtually unheard with these tumors.

“This is the first step, a critical step,” said the study’s leader, Dr. Gregory Friedman, a childhood cancer specialist at the University of Alabama at Birmingham.“Our goal is to improve on this.”

Dr. Gregory Friedman, a childhood cancer specialist n Birmingham, Alabama, is leading a study to treat a deadly type of childhood cancer with a treatment that involves infusing genetically modifies herpes virus directly into the brain to spur an immune system response to the cancerous cells.
Dr. Gregory Friedman, a childhood cancer specialist n Birmingham, Alabama, is leading a study to treat a deadly type of childhood cancer with a treatment that involves infusing genetically modifies herpes virus directly into the brain to spur an immune system response to the cancerous cells.
Denise McGill / Children’s of Alabama hospital

Friedman said that might be by trying it when patients are first diagnosed or by combining it with other therapies to boost the immune system.

The kids in the study were given the experimental approach after other treatments failed.

The study involved gliomas, which account for 8% to 10% of childhood brain tumors. Usually treated with surgery, chemotherapy or radiation, they often return. And when they do, survival averages under six months.

In such cases, the immune system has lost the ability to recognize and attack the cancer.

So scientists have been seeking ways to make the tumor a fresh target. They turned to the herpes virus, which causes cold sores and spurs a strong immune system response. Treovir, a suburban Philadelphia company, developed a treatment by genetically modifying the virus so it would infect only cancer cells.

Through tiny tubes inserted in the tumors, doctors gave the altered virus to 12 patients 7 to 18 years old whose cancer had worsened after usual treatments. Half also received one dose of radiation, which is thought to help the virus spread.

Eleven showed evidence in imaging tests or tissue samples that the treatment was working. Median survival was just over a year — more than double what’s been seen in the past.

As of last June — the cutoff for analyzing these results — four were still alive at least 18 months after treatment.

Tests also showed high levels of specialized immune system cells in their tumors. That suggests the treatment had recruited the help needed from the body to attack the disease.

No serious safety issues were seen, though there were several procedure-related complications and mild side effects including nausea, vomiting, diarrhea and fatigue.

Only one similar virus therapy for any type of cancer is approved in the United States — Imlygic, also a modified herpes virus, for treating melanoma, which is the most serious type of skin cancer.

Jake Kestler had the treatment when he was 12.

“It went very well. He lived for a year and four months after that,” long enough to celebrate his bar mitzvah, go with his family to Hawaii and see a brother be born, said his father Josh Kestler, a financial services executive from Livingston, New Jersey.

Jake died April 11, 2019, but “we have no regrets whatsoever” about trying the treatment, said Kestler, who with his wife has started a foundation called Trail Blazers for Kids to further research.

“It’s a devastating disease for these patients and their families,” said Dr. Antoni Ribas, a cancer specialist at UCLA who is president of the group holding the conference.

The early results suggest the virus treatment is helping, but they need to be verified in a larger study, which doctors are planning, Ribas said.

Friedman said studies are continuing in adults as well, and plans are in the works for other types of childhood brain tumors.

U.S. government grants and several foundations paid for the study, and several doctors who were involved have financial ties to Treovir.

This combination of microscope images shows immune cells in the brain tumor of a child before and after a treatment that involves using viruses to spur an immune system response to the cancerous cells. The image at right shows an increase in activated immune cells, indicated in brown.
This combination of microscope images shows immune cells in the brain tumor of a child before and after a treatment that involves using viruses to spur an immune system response to the cancerous cells. The image at right shows an increase in activated immune cells, indicated in brown.
University of Alabama Birmingham via AP