Summer 2009

Neuro-oncologist Joins Team Battling Brain Tumors

Though malignant brain tumors continue to confound those seeking a cure, neuro-oncologists are avidly exploring new medications and treatment protocols in an effort to extend life and improve its quality.

As part of that effort, neuro-oncologist Jennifer Clarke, M.D., recently joined a UCSF team that is developing and testing new treatments through clinical trials. Clarke, a 2006 graduate of the Neurology Residency Program at UCSF, returned to UCSF in 2008 after spending two years as a fellow at the Memorial Sloan-Kettering Cancer Center.

She says that one helpful approach is more sophisticated, team-based interpretations of contrast-enhanced MRI scans. "Five or 10 years ago, when enhancement showed up in images during radiation or combination therapy, it automatically implied tumor regrowth to the physicians," says Clarke. "Now we know that's not necessarily true."

At UCSF, a neuro-oncology tumor board — including neuro-oncologists, neurosurgeons, radiation oncologists, neuropathologists and neuroradiologists — meets weekly to discuss their patients' latest MRIs.

"Novel imaging provides us with additional information, and a team approach enables us to see these scans in the context of a particular treatment and the physical condition of the patient," says Clarke. "That helps us make the best possible clinical decision."

She also emphasizes that because day-to-day management of these patients often occurs in their home communities, collaboration must extend beyond UCSF. "We are fortunate to have good, working partnerships with community physicians to care for these complex patients," says Clarke.

Novel Treatment Approaches

Another advantage of a place like UCSF is that its volume of patients can support important clinical trials, which are the path to new treatments and more evidence-based clinical decisions.

Clarke notes, for example, that in addition to evaluating novel chemotherapy combinations — including one that combines bevacizumab with irinotecan — the team is exploring alternative methods of drug delivery.

One promising technique is convection-enhanced delivery of chemotherapy drugs. By circumventing the blood-brain barrier and delivering medication directly to the tumor or tumor cavity, convection-enhanced delivery might enable physicians to deliver higher concentrations of the drugs, while limiting side effects.

UCSF researchers have developed a technique to combine delivery of dye with the medication. This enables clinicians to use MR images to confirm that the drug is actually delivered in the desired distribution. A clinical trial incorporating this technique is due to begin this spring.

"It's important that an experienced team (neurosurgeon, neuro-oncologist and neuroradiologist) administer this treatment to ensure that the medicine is distributed and absorbed in the targeted area — and that it does not sit in the wrong area, which could damage healthy brain tissue," says Clarke.

For more information, contact Jennifer Clarke, M.D. at (415) 353-2966.

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