Last year, Canada Day held special significance for Aaron Miller. The 34-year-old resident of San Ramon, CA, was born in Montreal and moved to California as an infant with his family. On July 1, Aaron was diagnosed with brain cancer. A slow-growing tumor had become a tennis ball-sized mass that was pushing on one side of his brain. Mild muscle spasms and tingling in his fingers were the only warning signs that had emerged in the four months prior to the diagnosis.
Married and a father of two young kids, the diagnosis was shocking. “With a four-year-old and a four-month-old, this was the most devastating moment of my life. Knowing I might not be around for them or my wife really tore me apart,” says Aaron.
The Sutter neurologist who diagnosed Aaron’s brain cancer referred him immediately to Lawrence Dickinson, M.D., a Sutter clinician-researcher and brain cancer surgeon at Eden Medical Center. Dr. Dickinson assessed Aaron’s case and determined the tumor was encroaching on speech areas of the brain, and that immediate surgery would be required to remove the tumor while protecting healthy brain tissue.
The date of Aaron’s brain surgery also happened to be Dr. Dickinson’s birthday.
“Aaron's successful surgery was the best birthday present I could have received,” says Dr. Dickinson.“ Our team performed exceptionally well, and we accomplished a gross total resection of the neoplasm without injury to the nearby eloquent areas of his brain."
One week after the surgery at Eden Medical Center to remove the brain tumor, Aaron was transferred to a Sutter Health acute rehabilitation center in Oakland, CA, where he began speech therapy and physical therapy to regain full ability to talk and walk unaided. Once he had recovered from the surgery through therapies, he underwent daily chemotherapy and radiation treatment for seven weeks.
Six weeks after the completion of the chemotherapy and radiation treatment, a follow-up MRI showed full removal of the cancerous tissue from Aaron’s brain, and no metastases in the spinal cord or other parts of the body. “Dr. Dickinson had a skilled but lighthearted approach to my care that really made a difference during my recovery,” says Aaron. “I’d rather stay positive than be continually worried, and Dr. Dickinson and his team made sure I felt supported, cared for and that I kept a positive mindset.”
Another step that Dr. Dickinson took to further demonstrate a commitment to safeguarding care and follow-up: a sample of Aaron’s tumor was provided to scientists at Sutter’s California Pacific Medical Center Research Institute, where the Cancer Avatar Project is currently studying tumors of patients with some of the most aggressive, difficult-to-treat forms of cancer (see accompanying sidebar).
No other cancer is as challenging to effectively treat as brain cancer, or glioblastoma (GBM). Brain and other nervous system cancers are extremely rare. It is estimated that 18,020 adults (10,190 men and 7,830 women) will die from primary cancerous brain and nervous system tumors this year. The average survival rate for all malignant brain tumor patients is only36%.
“Malignant brain tumors are extremely difficult to effectively treat and provide long-term survival for patients afflicted,” says Dr. Dickinson. “One of the main reasons for this is the profound genetic variability of brain cancers, both within a single tumor and between patients with cancers such as GBM. This genetic variability means that targeted therapies often only have effect on a subpopulation of cells in any tumor. Therefore, these therapies only slow the progression of the disease and do not provide a cure.”
That’s why the Cancer Avatar Project is aimed at testing drugs, as single-agents or in combinations, that can overcome resistance to therapy and offer new options once patients’ tumors stop responding to the standard of care. Cancer Avatar Project strategies are aimed at helping overcome the limitations of existing approaches to treat brain cancer and some other types of cancer.
Aaron envisions the research being conducted through the Cancer Avatar Project and the new BrightMatter technology as potentially critical for other people with brain cancer or patients whose tumors may recur. “A year after my diagnosis and surgery, I’m grateful for my health, my family and the care I received at Sutter,” he says. “It’s also comforting to know that this type of groundbreaking research is underway to help care for other people with this potentially life-threatening illness.”
The Cancer Avatar Project:
Advancing Oncology Patient Care: The Cancer Avatar Project
CPMC’s Research Institute (CPMCRI) leads an innovative program to further Sutter Health's cancer precision medicine research through the Cancer Avatar Project — an approach leveraging living biology, genomics, high-throughput pharmacologic screening (HTDS) of anticancer agents, and bio-informatics. Through this project, CPMCRI is among few institutions worldwide using a unique method to create personalized treatment plans for cancer patients.
Here’s how: CPMCRI researchers collect tumor and blood samples from consenting Sutter Health cancer patients. Tumor samples are grown in the lab and tested for response to various drug treatments, and sequenced for DNA/genomic analyses. A portion of the tumor samples are also used to develop patient-derived xenograft (PDX) mouse models — or mouse avatars — that mimic the original patient’s tumor. This means the tumor samples can be continually used for additional drug treatment and genomic analysis, and included in a tumor bank for future Sutter cancer precision medicine research. Blood samples are used as a non-invasive liquid biopsy that evaluates the genomics of circulating tumor DNA (small fragments of genetic material) derived from the patient’s tumor.
Data from the Cancer Avatar Project will be used to predict patients’ response to drug treatment and inform the development of new clinical trials, as well as a liquid biopsy test to monitor cancer progression and/or response to treatment.
“The Cancer Avatar Project has the potential to significantly accelerate individualized cancer care and provide evidence-based treatment recommendations for patients with highly malignant, advanced cancers,” says Mohammed Kashani-Sabet, M.D., Medical Director, CPMC Cancer Center.
Philanthropy Brings Revolutionary Technology to Eden
In 2017, Eden became the first hospital in Northern California to acquire BrightMatter, thanks to generous community donors to Sutter Health affiliates across the East Bay. This innovative system uses advanced imaging, planning, navigation and robotics for complex brain and spinal surgeries, thereby improving care and outcomes for patients with brain tumors, stroke, head and spine trauma, and chronic neck and back pain. BrightMatter even makes surgery an option for some cases considered inoperable in the past.
“This technology has revolutionized the way we manage neurological patients,” Dr. Dickinson says. “For example, patients with brain tumors can now have surgery with much less risk of disturbing the important pathways of the brain.”
Using diffusion tensor imaging, BrightMatter automatically processes whole-brain tractography, allowing physicians to consider approaches for navigating around critical structures. The integrated imaging and navigation systems reveal details during surgery that can allow access to brain locations previously deemed inoperable.
Complementing this new visual information, a high-powered magnification system mounted on a robotic arm automatically follows the surgeon’s tools and shows the optimal view of patient anatomy in unprecedented detail. By improving surgical ergonomics, precision and time, BrightMatter can produce better results and save more patients’ lives.