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Brain Tumors


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:

  • Genetically modified immune system cells called CAR-T cells
  • Neural stem cells modified to deliver chemotherapy to advanced and treatment-resistant brain cancer
  • Nanoparticles that unleash cancer-killing therapies directly at tumor sites

Clinical trials for brain cancer

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].

Multidisciplinary care for all tumor types

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:

Promising new therapies

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:

  • Advanced immunotherapy and gene therapy clinical trials including using modified T cells to fight brain tumors
  • Revolutionary neural stem cell therapy that delivers chemotherapy directly to tumors
  • Promising research into immunotherapeutic approaches to killing brain cancer cells using nanoparticles
  • Neurosurgeons who expertly perform minimally invasive procedures — including endoscopic and image-guided surgery — to remove as much tumor tissue as possible while preserving quality of life
  • Leading-edge radiation therapy, including ultraprecise helical TomoTherapy, that focuses high doses of radiation on tumors while sparing surrounding healthy brain tissue
  • Noninvasive, alternating electric field therapy that disrupts tumor cell division
  • Genetic testing and customized drug therapy tailored to the molecular profile of brain tumors
  • Surgical devices, invented at City of Hope, designed to release tumor-killing nanoparticles, engineered T cells and other treatments directly into brain tumors
  • Leading-edge spinal surgery techniques, including single incision, minimally invasive techniques, developed at City of Hope, that transform long and complicated procedures into shorter, safer, more effective surgeries
  • A brain tumor board that meets at least twice a month to discuss patient treatment plans, allowing for tailored and individualized treatment
  • Palliative procedures designed to improve quality of life

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.

Request a consultation

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.



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

What are brain tumors?

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:

  • Breast
  • Lung
  • Melanoma

Types of brain cancer (primary)

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:

  • Meningiomas are most often benign. They sprout not from brain tissue itself but from thin, protective layers of the brain called the meninges. Meningiomas tend to grow slowly and can become quite large before causing symptoms. Approximately one-third of brain tumors are meningiomas.
  • Gliomas, another common type of brain tumor, arise from cells (called glia) in the brain that form a protective and supportive “glue” around neurons. Most malignant brain tumors are gliomas. Several tumor types arise from glial cells including:
  • Astrocytomas develop from star-shaped brain cells called astrocytes and are the most common form of glioma. Aggressive astrocytomas, called glioblastoma multiforme, are the fastest-growing type of malignant brain tumor. Astrocytomas tend to spread tentacle-like through normal brain tissue, making them difficult to remove surgically. Astrocytomas are rated based on how fast they grow — from high grade (fast-growing) to low grade (slow-growing).
  • Oligodendrocytomas develop from cells called oligodendrocytes. They are more likely to grow slowly but can become more aggressive over time. Like astrocytomas, oligodendrocytomas tend to infiltrate normal brain tissue, making this type of tumor difficult to remove surgically.
  • Ependymomas grow from ependymal cells, which are found in the ventricles. Unlike astrocytomas and oligodendrocytomas, this type of tumor usually does not grow into normal brain tissue, making it more likely to be removed with surgery. Since this type of brain tumor affects the ventricles, it can block the flow of cerebrospinal fluid and cause a condition called hydrocephalus.
  • Mixed gliomas are tumors made up of two or more types of glioma cells, including astrocytomas, oligodendrocytomas and ependymomas. Mixed gliomas usually are treated based on the behavior of the most aggressive cells in the tumor.

Other brain tumor types

  • Pituitary tumors are usually benign tumors that start in the pituitary gland and represent around 15 percent of all primary brain tumors.
  • Chordomas are rare, slow-growing tumors that form along the spine and sometimes metastasize to other parts of the body.
  • Schwannomas, also called acoustic neuromas, neurilemmomas and vestibular schwannomas, develop from Schwann cells — which form the protective coating around nerve fibers. They are usually slow-growing and benign.
  • Gangliogliomas are extremely rare tumors, more common among children and young adults, that involve neurons and glial cells.
  • Craniopharyngiomas grow near the base of the brain, and because they develop in close proximity to the pituitary region and optic nerves, may affect hormones and vision when they grow.
  • Lymphomas are aggressive tumors that start in immune system cells called lymphocytes. Lymphomas that begin in the brain are more common among people who are immunocompromised, such as those with HIV.
  • Medulloblastomas are fast-growing tumors that develop from neuroectodermal cells in the cerebellum.

How brain cancer develops

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:

  • meninges, thin layers of tissue that surround the brain and spinal cord
  • ventricles, fluid-filled spaces in the center of the brain
  • cerebrum, the largest and most developed part of the brain that governs complex things like emotions, personality and judgement
  • cerebellum, located in the lower back part of the brain, and the seat of motor control
  • brain stem, located at the base of the brain and connected to the spinal cord, which controls involuntary functions like breathing and heart rate

Getting brain cancer

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.                  

Brain tumor grading

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:

  • Grade I is benign tumor tissue that grows slowly and closely resemble normal brain cells.
  • Grade II is malignant tissue that look less normal than Grade I cells.
  • Grade III describes fast-growing (anaplastic) malignant cells that look very different from Grade I cells.
  • Grade IV are fast-growing malignant cells that look the most abnormal.

Lower grade brain tumors grow more slowly than high-grade, but may over time develop into high-grade tumors.

What increases your risk of brain cancer?

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:

  • Radiation exposure from high-dose radiation therapy and other sources.
  • Age; people tend to be diagnosed either in childhood or as older adults.
  • Immune system disorders increase the risk that a person will develop lymphomas affecting the brain and spinal cord.

Family history and genetic influences

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.

  • Tuberous sclerosis increases the risk of certain low-grade astrocytomas and benign tumors of the brain, heart, skin and other organs.
  • Von Hippel-Lindau syndrome increases the risk of developing benign or malignant tumors in different parts of the brain and spinal cord; and other parts of the body including the pancreas, kidney, adrenal gland and inner ear.
  • Neurofibromatosis type 1 and 2 are nerve tumors of the skin, brain or spinal cord. Problems with the NF1 gene are much more likely to be implicated as a cause of brain tumors than changes to NF2.
  • Li Fraumeni cancer syndrome is caused by changes to a gene called TP53 and is associated with a higher risk of developing gliomas and other types of cancer including sarcomas, leukemia and breast cancer.
  • Other rare syndromes that increase the risk of brain tumors include Gorlin syndrome, Turcot syndrome and Cowden syndrome.

Brain cancer prevention

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 cancer symptoms

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:

  • Headaches
  • Nausea and vomiting
  • Seizure
  • Weakness or numbness in areas such as face, arms or legs
  • Balance and coordination problems
  • Behavior and personality changes
  • Memory problems
  • Blurry vision
  • Speech or hearing problems
  • Paralysis
  • Other neurologic impairment

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.

Diagnosing brain tumors

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.

Initial tests to diagnose brain cancer

  • A neurologic exam is a test to find out of there are neurological problems, including motor and sensory issues.
  • MRI (magnetic resonance imaging) uses magnets and radio waves to create a series of pictures of the brain and nearby structures.
  • CT (computed tomography) scan uses X-rays to provide detailed images of the brain and spinal structures, revealed as thin cross-sections.
  • PET (positron emission tomography) scan uses a radioactive tracer to locate cancer cells and measure their activity.


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:

  • The tumor’s growth potential
  • How the tumor might evolve over time

There are two main ways to perform biopsy for brain cancer, including:

  • Stereotactic biopsy involves guiding a needle to the tumor site in order to extract a small sample of the tumor tissue. Needle biopsy is most often used when the tumor is in an especially risky or sensitive area of the brain.
  • Surgical biopsy is done when imaging reveals a tumor that may benefit from being removed surgically. This type of biopsy usually involves removing a section of the skull — called a craniotomy — and taking out most or all of the tumor.

If it is suspected that cancer has spread through the cerebrospinal fluid, a spinal tap may be performed:

  • Spinal taps are used to test for cancer cells in the cerebrospinal fluid, usually after a brain tumor is already diagnosed. A spinal tap is more commonly used when certain tumor types are suspected to have spread there, such as a lymphomas or ependymomas.

Brain tumor treatment options

It is a privilege for me to treat patients — for them to trust me with their care. Benham 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:

  • Tumor type and grade
  • Size of the tumor
  • Where the tumor is located in the brain
  • Your health status

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.

Treatment approach

Our treatment approach involves:

  • An initial consultation with deeply experienced brain tumor experts, who will provide an accurate diagnosis, followed by a personalized treatment strategy
  • Input from experts in various subspecialties at every stage of your treatment
  • A treatment plan that evolves as new treatments and clinical trials become available
  • Palliative care, pain management and counseling

Comprehensive care

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.


When routine therapies stop working, you have options here that you don’t have elsewhere. Mike Chen, M.D., Ph.D., neurosurgeon

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:

  • Remove a small swatch of tumor tissue (a biopsy) for diagnosis.
  • Remove an entire brain tumor.
  • Stop brain tumor cells from spreading.
  • Slow the growth of a brain tumor.
  • Prevent a tumor from returning.
  • Provide direct access for chemotherapy, implants and genetic treatments.
  • Ease symptoms caused by the tumor like headaches or seizures.

Our neurosurgery team’s focus on researching and treating brain tumors also means they can target tumors that elsewhere were considered inoperable.

A focus on minimally invasive techniques

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:

  • Intraoperative cortical mapping, which gives the surgeon a computerized map of key brain regions, including speech, motor and sensory centers. By avoiding these critical areas, the risk of damage to brain tissue is minimized while still allowing as much of the tumor to be removed as possible.
  • Image-guided surgical navigation, which helps to remove tumors that are difficult to visualize, or are located in high-risk areas of the brain, by using preoperative magnetic resonance imaging (MRI).
  • Endoscopic surgery, performed through an endoscope — a thin, lighted tube with a small opening that accommodates tiny surgical tools. Smaller incisions reduce pain and the risk of infection.

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.

Spinal surgery excellence

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.

Neurosurgeon innovators

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.

Types of brain tumor surgery

  • Biopsy involves taking a small sliver of brain tumor tissue and examining it under a microscope. It is used to determine the type and grade of brain tumor.
  • Craniotomy involves surgically removing a section of the skull so that the neurosurgeon can reach the area of the brain affected by the tumor. The skull section is replaced at the end of surgery.
  • Craniectomy, like craniotomy, involves surgically removing a section of skull, however it is not replaced post surgery.
  • Debulking involves surgically reducing the size of the tumor.
  • Partial removal is removing only part of the tumor so as to not damage normal tissue.
  • Complete removal involves surgically removing the entire tumor.
  • A shunt creates a drainage system by funneling excess fluid from the brain to outside the body.
  • An Ommaya reservoir is a small, dome-shaped device that is place under the scalp. A tube is attached which may be used to deliver fluids, like chemotherapy, or extract fluids, like cerebrospinal fluid.
  • Skull base surgery is both a procedure to remove tumor tissue from the skull base area and describes tumors found in that area of the central nervous system.
  • Transphenoidal surgery is a surgical method typically used on pituitary adenomas and craniopharyngiomas.

Radiation Therapy

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:

  • Helical Tomotherapy, which delivers focused radiation directly to brain tumors while minimizing any impact on surrounding brain tissue
  • TrueBeam radiotherapy, an image-guided radiation system, that delivers ultraprecise beams of radiation directly at tumors while preserving surrounding healthy tissue

Neural Stem Cell Therapy

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 — that 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.

Targeted Therapy

City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and use 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 utilize the latest in technology and innovation to treat adult and pediatric brain cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Anatomic Pathology

Massimo D'Apuzzo, M.D., Ph.D.

Clinical Specialties

  • Anatomic Pathology

Diagnostic Radiology

Bihong (Beth) Chen, M.D., Ph.D.

Clinical Specialties

  • Diagnostic Radiology
Julie Ann Ressler, M.D.

Clinical Specialties

  • Diagnostic Radiology

Medical Oncology

Jana Portnow, M.D.

Clinical Specialties

  • Medical Oncology


Neal Prakash, M.D., Ph.D.

Clinical Specialties

  • Neurology


Behnam Badie, M.D., F.A.C.S.

Clinical Specialties

  • Neurosurgery
Mike Y. Chen, M.D., Ph.D.

Clinical Specialties

  • Neurosurgery
Rahul Jandial, M.D., Ph.D.

Clinical Specialties

  • Neurosurgery

Pediatric Hematology-Oncology

Clarke Anderson, M.D.

Clinical Specialties

  • Pediatric Hematology-Oncology

Radiation Oncology

Savita Dandapani, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology
Eric H. Radany, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Brain tumor clinical trials and research

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.

Finding better treatments

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.


Clinical trials for recurrent disease

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:

  • White blood cells known as T cells are isolated and engineered to express a protein of novel design called a chimeric antigen receptor (CAR).
  • This CAR instructs the T cells to recognize and kill target cells that express IL13Rα2, a receptor readily detected on the majority of malignant gliomas, but not on normal brain tissue.
  • At the time of surgery, a catheter system will be placed for local delivery of the reprogrammed T cells at the tumor site. 
  • Following recovery from surgery and cell manufacture, research participants will receive weekly injections of the CAR-T cells for three weeks, with an option for an additional three week treatment course.

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.

  • During removal or biopsy of tumor, research participants will receive local injections of genetically-modified NSCs.
  • These NSCs express the activating enzyme cytosine deaminase (CD), which converts the prodrug 5-fluorocytosine (5-FC) into the chemotherapy agent 5-fluorouracil (5-FU).
  • Research participants will then take 5-FC orally for seven days.
  • As the 5-FC crosses into the brain, the CD-expressing NSCs (which have migrated to residual cancer sites) are expected to convert the 5-FC into 5-FU.
  • The 5-FU and its toxic metabolites will diffuse out of the NSC to preferentially kill rapidly dividing tumor cells.

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:


  • A virus (Toca 511) is injected into the tumor. This virus was designed to infect only the brain tumor cells and leave the normal cells alone. When it infects a cell, it adds a gene to the cell which encodes for an enzyme that can convert an antibiotic drug (Toca FC) into a toxic chemotherapy (5-FU), selectively in the tumor.
  • This drug (Toca FC) is given orally every few weeks, and it kills the tumor cells that have enough copies of this enzyme to convert Toca FC to 5-FU.
  • The tumor cells that are infected but don't have enough of the enzyme act as a reservoir — they start the process over again — spreading the infection for a few more weeks, and these cycles are repeated over and over again until the entire tumor is potentially gone.

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.


Clinical trials for newly diagnosed patients

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.

  • Patients in arm 1 will receive ICT-107 in combination with the standard of care, temozolomide (TMZ).
  • ICT-107 will be given once a week for four weeks in the induction phase.
  • During the maintenance phase, ICT-107 will be given monthly for the 11 months after induction and once every six months thereafter until depletion of supply or confirmation of progressive disease.
  • Patients in arm 2 will receive TMZ with a blinded control.
  • Control will be given once a week for four weeks in the induction phase.
  • During the maintenance phase, Control will be given monthly for the 11 months after induction and once every six months thereafter until depletion of supply or confirmation of progressive disease.


Clinical trials for patients with metastatic disease

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. 

  • In this study, the neurosurgeon will place up to two microdialysis catheters in the brain tumor (if only a biopsy is being done) or in the nearby brain tissue. The catheter (which is about the size of a piece of spaghetti) is smaller than the standard needle used to do brain biopsies. 
  • Beginning at least 24 hours later, patients receive eribulin mesylate intravenously (IV) over two to five minutes on day 1.
  • Brain fluid samples are collected for approximately 72 hours and the microdialysis catheter is then removed.
  • Beginning at least two weeks after tumor resection or biopsy, patients may continue to receive eribulin mesylate IV over two to five minutes on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

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.



Living with Brain Cancer

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.

Learn more about the resources listed below at our Living with Cancer or Supportive Care Medicine sites.

  • Managing side effects and symptoms
  • Pain management
  • Navigating the health care system
  • Your emotional, social and spiritual health
  • Handling and coping with stress
  • Staying healthy and active
  • Healthy cooking and eating
  • Healing arts
  • Caregiver skills
  • Restoring normalcy in your family, job or school routine

Bridget, brain tumor survivor

Faced with brain cancer, Bridget refused to become a statistic. She sought a second opinion at City of Hope.


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