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Treating Neurocognitive, Physical Limitations in Patients with Brain Cancer

Duke neuro-oncologist leads supportive care research efforts

Physician consulting with patient with cancer

While radiation and chemotherapy treatments for brain cancer can help shrink tumors, they can also lead to neurocognitive limitations that severely affect a patient’s quality of life. A team of experts at the Duke Cancer Institute that specializes in supportive care research is working to develop new ways to help ameliorate those symptoms during and after treatment.

Katherine B. Peters, MD, PhD, Duke neuro-oncologist and director of supportive care at the Preston Robert Tisch Brain Tumor Center, explains that 50% to 90% of patients who receive radiation as part of their treatment develop some kind of neurocognitive dysfunction, such as short-term memory loss, attention deficits, and multitasking challenges. This in turn can lead to physical limitations, including seizures, blood clots, fatigue, nausea, and vomiting.

“For our patients with primary or metastatic brain tumors, they wake up one day with both a neurologic and cancer diagnosis, so they have some significant challenges on both fronts,” says Peters. “The tumor itself can cause neurologic and cognitive impairments, but the treatments can make those symptoms even worse.”

Duke researchers are actively recruiting for and designing studies to tackle these issues and improve the quality of life for patients. Peters is leading a randomized, multicenter, NIH-funded phase II study for newly diagnosed patients with high-grade glioma that is studying a compound called BMX-001 (also known as manganese butoxyethyl pyridyl porphyrin), which is administered concurrently with radiation therapy plus temozolomide. This combination helps protect normal brain tissue while increasing the effectiveness of the radiation, Peters says. In the initial trial, results of which were presented at a recent American Society for Radiation Oncology meeting, participants showed improved survival and cognition after treatment. This same compound is also being evaluated as treatment for head and neck cancer at Duke.

“We’re proud to have been the first to bring this compound forward, and we are very hopeful that it can change the lives of patients with brain cancer,” she adds. “It’s truly a melding of the clinical trial world and the supportive care world to improve patient outcomes.”

In addition to this trial, Peters notes that SPIRIT, a large, soon-to-launch phase III clinical trial for a new combination medicine, could help improve cognition in any patient with a history of cranial radiation for metastatic brain cancer and primary brain tumors—including those who have had pediatric cancers. This broad inclusion criteria gives all brain cancer survivors the change to participate in the study, she says.

“We’re making great strides in how to treat cancer, but now we need to increase efforts to treat the patient, caregivers, and the family through that supportive lens,” she adds.

Peters is also concerned with the global aspect of supportive care, which includes providing resources that benefit referring physicians. “When providers send their patients to Duke, they should know that their patients can take advantage of all of our supportive care services at the cancer care clinic,” she says. Specialists include social workers, a child life specialist, a neuropsychologist, and a psychiatrist dedicated to this patient population. “That expertise alone can really benefit outside providers, and we are continuing to think of interesting ways such telehealth or e-consult strategies to help them help our collective patients,” she adds.