I never expected to get my life back … but the feedback I got from everyone that I worked with at City of Hope was there were things that could be done." Joan Rose-Hall, patient
Getting treatment for brain and spinal tumors at City of Hope puts you at the center of some of the most innovative and groundbreaking research and clinical trials for brain cancer in the world. It gives you access to promising treatments that directly target tumors — and the behavior of your individual cancer.
Our Brain Tumor Program has several exciting experimental therapies — some of which are only offered at City of Hope — as part of our clinical trials program. We are studying new treatments for brain tumors including:
If you have a newly developed or recurrent brain tumor and are interested in learning about our clinical trials, or in referring a patient for enrollment, please call 626-471-9393 or send an email to [email protected].
"In the past we never treated patients who had cancer that spread to the brain because we considered it terminal. But now that we’ve succeeded with drugs, partly invented at City of Hope, people with advanced cancer are living longer and longer." Rahul Jandial, M.D., Ph.D., neurosurgeon and scientist
When you get brain tumor treatment at City of Hope, you are partnering with a world class team of experts spanning multiple disciplines, who see and treat challenging and complex brain tumors on a daily basis. And you have access to transformative surgical methods and technology, groundbreaking research studies and leading-edge radiation therapy. We treat all tumor types, including:
City of Hope’s focus on basic research keeps us on the cusp of big discoveries. We are the only cancer center in the country that is injecting cancer-killing immune cells directly into the brain to treat patients with advanced brain tumors — in an effort to produce a more potent response. And we were the first research institution in the world to use neural stem cells in patients with glioblastoma.
Our commitment to providing exceptional care includes:
City of Hope’s team of neurosurgeons, neuro oncologists, researchers, nurses, radiologists and genetic counselors work together closely at all stages to provide seamless, coordinated care. We balance that approach with personalized medicine — not just when it comes to your cancer, but the kind that makes you feel supported throughout your treatment. And our commitment to personalized care means preserving your quality of life is at the heart of your treatment.
City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for more than a decade, and is a National Cancer Institute-designated comprehensive cancer center.
City of Hope’s world renowned brain tumor care team uses the latest technology and innovation to treat cancer while providing compassionate care. Call 800-826-HOPE or request an appointment online.
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Brain tumors are exceedingly rare — less than 1 percent of the population is diagnosed with a malignant (cancerous) brain tumor during their lifetime. Cancers that begin in the brain – primary brain tumors – are uncommon, while those that travel to brain tissue from other organs – called metastatic tumors – are more frequently diagnosed.
In 2016, around 78,000 people in the United Stated will be diagnosed with a primary brain tumor — most of which will be benign (noncancerous) — and approximately 200,000 will be diagnosed with brain tumors that metastasized from other parts of the body. The most common cancers that metastasize to the brain include:
The brain is a three-pound mass of fatty tissue mainly composed of nerve cells — which convey messages from the brain and spinal cord to the rest of the body — and glial cells, which surround and support nerve cells. The brain controls basic functions like breathing and more complex ones like emotions and personality.
Other structures in and around the brain include the:
Brain cancer develops when abnormal cells in the brain and spinal cord grow and divide in an uncontrolled way, interfering with normal brain functioning. There are more than 120 types of brain and central nervous system tumors and they are classified based on the origin of the cells and how aggressively they behave.
Primary brain tumors are broadly categorized based on where they develop. Some tumors develop within brain tissue while others develop nearby (but outside the brain), putting pressure on brain tissue. Different brain tumor types require different treatments. The main types of primary brain tumors include:
While other cancer types are staged based on how quickly the disease progresses and how far from the primary site they spread, brain and spinal cancers almost never travel to other body parts. Brain tumors are graded based on their growth rate and how the cells appear under a microscope:
Lower grade brain tumors grow more slowly than high-grade, but may develop into high-grade tumors over time.
Things that put you at higher risk for getting brain cancer are called risk factors. There are very few known causes of primary brain tumors, although age, certain genetic syndromes and radiation exposure play a role in some cases. Factors that increase the risk of a brain tumor include:
Having multiple family members with brain tumors, in rare cases, can dictate whether a person develops a brain tumor. Fewer than 5 percent of glioma patients have a family history of brain tumor.
Symptoms of brain cancer depend on which parts of the brain are involved and how quickly the tumor is growing. For slower-growing tumors, symptoms may come on gradually, while for more aggressive tumors they can come on quickly. Because there tend to be no early symptoms, brain tumors may be advanced by the time they are discovered.
Both benign and malignant tumors cause similar symptoms, including:
Headache is one of the most common symptoms of brain cancer — it may be caused by a tumor pressing on the brain, swelling or bleeding — and tends to be worse in the morning.
Other medical conditions share these symptoms. If you have any of these conditions, you may need further consultation to rule out brain cancer.
Nutrition and exercise can influence the development of neurons (a process called neurogenesis). Combining a good diet with exercise may help to reduce your risk of brain cancer.
Brain tumors are highly complex, requiring an expert and deeply experienced team that can accurately diagnose your tumor type — so that you get the best and most effective treatment. City of Hope’s team of highly trained experts use their clinical expertise, honed by seeing many different tumor types, to provide you with the most accurate diagnosis.
A biopsy (a thin sliver of tissue taken from the tumor) may occur after initial imaging and neurologic testing, or it may occur at the earliest stage of diagnosis. That section of tissue is then evaluated based on factors such as:
There are two main ways to perform biopsy for brain cancer, including:
If it is suspected that cancer has spread through the cerebrospinal fluid, a spinal tap may be performed:
It is a privilege for me to treat patients — for them to trust me with their care." Behnam Badie, M.D. chief of Neurosurgery, director of Brain Tumor Program
City of Hope’s approach to treating brain cancer starts with a coordinated, multidisciplinary care team whose main goal is finding a treatment plan that extends your life. We combine leading-edge technologies — like minimally-invasive surgery and the latest radiological approaches — with research and clinical trials not found anywhere else.
Your team works with you at every stage of treatment. Our planning begins by considering the following:
For certain low-grade tumors, the best first course may be observation, while higher grade tumors may be treated using chemotherapy and radiation. Your treatment course will be personalized based on your specific tumor type.
Our treatment approach involves:
City of Hope is one of only a few dozen centers in the country that treat brain tumors using a comprehensive approach — by a team whose sole focus is treating this type of cancer. Your care includes regular interaction and input from a team that includes neurosurgeons, oncologists, radiologists and pathologists — along with researchers who collaborate with clinical staff regularly to quickly bring potential therapies from the lab to patients.
Surgery for brain cancer is often the first step in the treatment process for brain tumors. Deciding whether to remove a tumor depends on if it can be done safely, and how much normal brain tissue is involved. In some cases, surgery may be performed to reduce the tumor size, but may not remove all cancerous tissue. For operable brain tumors, surgically removing cancer could cure early stage disease.
Surgery for brain tumors most often is used to:
Our neurosurgery team’s focus on researching and treating brain tumors also means they can target tumors that elsewhere were considered inoperable.
When routine therapies stop working, you have options here that you don’t have elsewhere. Mike Chen, M.D., Ph.D., neurosurgeon
City of Hope’s neurosurgeons specialize in using minimally invasive procedures whenever possible. By using fewer incisions and making smaller cuts, our surgeons can extract the tumor with minimal impact to surrounding healthy brain tissue. Minimally invasive procedures used at City of Hope include:
Our neurosurgeons work closely with radiation and medical oncologists so that multiple treatments can be performed during one procedure. For example, applying chemotherapy directly to the tumor site during surgery, which can kill remaining tumor cells and reduce the likelihood of recurrence.
City of Hope is also developing a miniaturized surgical system to allow brain surgery to be even less invasive, with an even lower risk of complications.
Many cancer patients develop spinal metastases yet few specialists know how to safely navigate this complex region of the body. City of Hope neurosurgeons regularly treat difficult spinal cases — and use their expertise to design innovative surgical approaches. Our team invented a technique designed to reduce the number of incisions needed to perform complex spine surgery, resulting in a safer procedure with fewer complications, less bleeding and faster healing.
All City of Hope neurosurgeons have active research laboratories — with projects ranging from defining the behavior of metastatic brain tumors to refining the delivery of MRI-guided gene therapy to brain tumors to inventing smaller, nimbler tools for hard-to-reach tumors.
Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. City of Hope offers radiation treatments using state of the art technology that directly target cancer cells and minimize harmful effects to the brain. Our advanced radiation techniques include:
Even in situations when surgeons can remove a brain tumor, invasive tumor cells can continue to spread throughout the brain. Researchers at City of Hope are engineering neural stem cells, which are naturally drawn to tumor cells, to deliver chemotherapy and other tumor-killing agents to the brain while minimizing side effects and toxicity to normal brain tissue.
City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and uses medications to stop them from growing. This approach involves creating targeted therapies: drugs that would work best to treat specific cancers.
Although brain tumors have fewer molecular targets than other cancer types, high-grade brain cancer patients at City of Hope have their tumors molecularly profiled in the event that the cancer can be targeted. Research is ongoing to find new targets for brain tumors.
Chemotherapy is cancer treatment that uses drugs to either kill cancer cells or stop them from growing. The blood-brain barrier keeps most chemotherapy drugs from being absorbed by the brain, but advances in gene and immunotherapy at City of Hope are allowing drugs to reach brain tumors.
City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat adult and pediatric brain cancer — coupled with an enduring belief in providing compassionate care. Call 800-826-HOPE or go online to request an appointment.
I think it is really important as an oncologist to work toward finding the cure. We have to find better treatments for brain tumors." Jana Portnow, M.D., associate director, Brain Tumor Program
City of Hope is a hub of innovation and progress when it comes to treating brain tumors. Our research and clinical teams work together to advance therapies that more effectively — and directly — target brain tumors. We are researching immunotherapy as a way of disabling cancer cells and finding unique ways to allow cancer drugs to cross the blood-brain barrier.
We are world leaders in the field of neural stem cell therapy, a groundbreaking method of delivering chemotherapy drugs directly to tumor sites within the brain — and were the first in the world to apply this exciting breakthrough therapy to brain cancer.
The key to finding better treatments for aggressive disease is the constant collaboration between researchers, clinicians and oncologists — who move therapies swiftly from our on-campus research labs to patients. The quality and frequency of this interaction allows us to get potentially life-extending therapies to our patients quickly.
For more information about the brain tumor studies listed below, including eligibility criteria, please call: 626-471-9393. For a summary of these studies visit the City of Hope clinical trials website.
IRB #13384: Phase I Study of Cellular Immunotherapy Using Central Memory Enriched T Cells Lentivirally Transduced to Express an IL13Rα2-Specific, Hinge-Optimized, 41BB-Costimulatory Chimeric Antigen Receptor and a Truncated CD19 for Patients with Recurrent/Refractory Malignant Glioma
In this ‘first in human’ clinical study, we are evaluating the safety and feasibility of reprogramming a patient’s own immune system to target malignant glioma. For this study:
If you are interested in learning more about this clinical trial, or in referring a patient for enrollment, please call 626-471-9393 or email [email protected]. For a summary of this study including the full eligibility criteria, visit City of Hope’s clinical trials website at http://clinicaltrials.coh.org and enter “13384” in the keyword search.
IRB# 13401: A Phase I Study of Cytosine Deaminase-Expressing Neural Stem Cells with Oral 5-Fluorocytosine and Leucovorin for Treatment of Recurrent High-Grade Gliomas
Neural Stem Cells (NSCs) have a natural ability to home to tumor cells throughout the brain. They can be genetically modified to produce chemotherapy at sites of tumor. Neural stem cells are being investigated as a possible treatment for brain tumors.
It is hoped that this strategy will have a large “bystander effect,” meaning that one NSC can kill off many surrounding tumor cells while minimizing toxicity to healthy tissues. Some study patients will also take leucovorin with 5-FC. Leucovorin is an oral medication that can help 5-FU work better against cancer cells. A Rickham catheter, placed in the brain at the time of surgery, will be used to administer additional doses of NSCs every two weeks, followed each time by seven day courses of oral 5-FC (and possibly leucovorin).
If you are interested in learning more about this clinical trial or in referring a patient for enrollment, please call 626-471-9393 or email at [email protected]. For a summary of this study including the full eligibility criteria, visit City of Hope’s clinical trials website at http://clinicaltrials.coh.org and enter “13401” in the keyword search.
IRB #13116: A Phase I Gene Therapy Trial of the Safety and Tolerability of Toca 511 in Patients Recurrent High Grade Glioma
This is a very exciting new experimental gene therapy treatment for high grade brain tumors. The basic concept is:
If you were diagnosed with recurrent high grade glioma (glioblastoma multiforme, anaplastic astrocytoma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma) — that has increased in size following treatment with surgery, radiation therapy and temozolomide — you may be eligible for the Toca 511 and Toca FC studies.
Your doctor will be able to review with you these and other eligibility criteria. For more information about the Toca 511 and Toca FC studies, please contact Jana Portnow, M.D., or Behnam Badie, M.D., at 626-471-9393 or visit www.tocagen.com.
IRB #16062: Phase III Randomized, Double-blind, Controlled Study of ICT-107 in Glioblastoma
ICT-107 consists of dendritic cells, prepared from autologous mononuclear cells that are pulsed with six synthetic peptides that were derived from tumor associated antigens (TAA) present on glioblastoma tumor cells. This is a phase III study to evaluate ICT-107 in patients with newly diagnosed glioblastoma. Subjects will be randomized to receive standard of care chemoradiation (temozolomide (TMZ) with either ICT-107 or a blinded control. Reinfusion with the pulsed dendritic cells should stimulate cytotoxic T cells to specifically target glioblastoma tumor cells.
IRB #14312: An Intracerebral Microdialysis Study to Determine the Neuropharmacokinetics of Eribulin in Patients with Brain Tumors
Despite the use of surgery, radiation and chemotherapy, malignant brain tumors are very difficult to treat successfully. One reason that chemotherapy drugs might not be effective is that the drugs may not be able to get into the brain tumor and kill the cancer cells. Eribulin is approved for use by the Food and Drug Administration to treat advanced breast cancer. However, it is experimental in the treatment of brain metastases. This study will see if doses in the human brain can also reach levels high enough to be effective.
Another objective of this study is to evaluate the safety and effectiveness of eribulin in participants who choose to continue to receive the drug after the microdialysis portion of the study is complete. Your treatment on this part of the study will last for as long as your tumor is not growing and you are not having any unmanageable side effects. However, if you were previously treated with eribulin, you are eligible to participate in the microdialysis portion of this study only.
After your participation in the study ends, your condition will be followed for an additional 30 days or until all side effects have resolved, whichever is longer. About six to eight people will take part in this study.
IRB #15331: A Phase 2 Study of Abemaciclib in Patients with Brain Metastases Secondary to Hormone Receptor Positive Breast Cancer, Non-small Cell Lung Cancer, or Melanoma
This study is being done to see how safe an investigational drug is and how well it will work to help people with cancer that has spread to the brain due to certain types of breast cancer, lung cancer and melanoma. The main reason for you to take part in this study is to help in answering the following research question: Whether abemaciclib (study drug) can help patients with breast cancer, nonsmall cell lung cancer, or melanoma whose disease has spread to the brain.
Being diagnosed with brain cancer is a difficult and life-altering event. In addition to leading-edge care, City of Hope provides all patients with counseling, physical therapy and nutritional support.
When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey. That support includes everything from talk therapy to meditation to being paired up with a patient navigator.
Faced with brain cancer, Bridget refused to become a statistic. She sought a second opinion at City of Hope.
Like many breast cancer survivors, Joan didn’t know that breast cancer is prone to spread, or metastasize, to the brain. When her cancer returned in the form of a brain tumor, Joan came to City of Hope.