June 17, 2015 | by David Levine
Jana Portnow, M.D., associate director of the Brain Tumor Program at City of Hope, didn’t expect to specialize in treating brain tumors. But, early in her career, she undertook a year of research on pain management and palliative care and, in that program, got to know many patients with brain tumors. After that, there was no going back.
Portnow said she feels a special affinity for patients with brain cancer, even though she often seems to be giving them bad news. "They are grateful for what I do for them and surprisingly not resentful that their prognosis is not good," she said. "I think that I would feel very angry if I had an illness that took away my ability to communicate or walk.”
That capacity to put herself in her patients’ place may be one reason her patients feel that same affinity for her, understanding that Portnow is trying everything she can to give them more time.
"Brain tumors affect the organ that is the key to our humanity,” Portnow said. “Our sense of self comes from our brain. And because brain tumors are so invasive and deadly, I want to help people battling brain cancer as much as I can."
A great deal of Portnow’s work is focused on developing new treatments for brain tumors, specifically for glioblastoma, the most common type of malignant primary brain tumor in adults (“primary” means that it originated in the brain) and the most aggressive.
"The median survival is only about 15 months, and less than 5 percent of patients are alive five years after diagnosis," Portnow said, noting that glioblastoma is one of the few cancers that can't be cured surgically. "These tumors are very invasive. We know that there are always tumor cells left behind. We don't even talk about margins, as is standard practice for other cancers, because you can't bet clear margins when resecting glioblastoma."
Delivering chemotherapy at the tumor site
Portnow’s current work is focused within City of Hope's neural stem cell program, in which these cells are genetically modified to carry specific proteins past the blood-brain barrier. Neural stem cells have a natural ability to track to tumor cells. After being injected directly into the brain or administered by vein, the proteins in the neural stem cells convert a prodrug to an active chemotherapy agent at tumor sites in the brain.
"We are not using the neural stem cells to directly treat cancer. They are vehicles for delivering drugs to the brain, producing higher concentrations of chemotherapy locally to fight the tumor," Portnow said.
A first-in-human study at City of Hope has already documented the safety and proof-of-concept of this neural stem cell-based treatment strategy, and a formal phase I study is currently underway. Portnow is working with Karen Aboody, M.D., professor in the Department of Neurosciences and Division of Neurosurgery, and Behnam Badie, M.D., chief of the Division of Neurosurgery and director of the Brain Tumor Program, to refine the approach and make it more broadly available.
The potential of immunotherapies
Portnow is also involved with developing immunotherapies for brain tumors in collaboration with Badie; Christine Brown, Ph.D., associate director of the T Cell Immunotherapy Laboratory; and Stephen J. Forman, M.D., the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation. She's particularly excited about a clinical trial using CAR-T cell therapy in patients with recurrent high-grade gliomas. That trial, a phase I study, is being led by Badie and has just started accruing patients.
Portnow finds collaborating with her colleagues to be sustaining. "California is certainly a nice place to live,” said Portnow, who grew up in the suburbs of New York City, “but what really keeps me here is that City of Hope is a wonderful place to work. The atmosphere is collegial and supportive, which is not always the case in research institutions."
Learn more about brain tumor treatment and research at City of Hope.
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