Following a blood clot removal, John McCain was diagnosed with Glioblastoma, a cancer with even worse prognosis than pancreatic cancer. For decades, patients diagnosed with Glioblastoma multiforme (GBM) received an almost certain death sentence, with average survival times measured in months. Yet the approval of the most scifi-esque cancer therapy to date, Tumor-treating fields (Optune, Novocure, NASDAQ:NVCR), has rekindled a flame of hope for these patients.
The news that glioblastoma was discovered during John McCain’s innocuous blood clot surgery has left many people curious about this type of cancer. Owing to its rarity, glioblastoma, or Glioblastoma multiforme (GBM), is a relatively obscure cancer known only by a small medical research community. This stands in stark contrast to the severity of a glioblastoma diagnosis, which caries only a 3-5% chance of surviving for 5 years. Perhaps even scarier is just how benign the onset of glioblastoma can be, with patients reporting only non-specific symptoms such as headache, nausea, and a slow loss of cognitive function.
On the research side, very little has been discovered about Glioblastoma. It is one of a few cancer types originating from glial cells (the most common “brain cell” that supports the neurons), and has been classified into four different types: classical, proneural, neural, and mesenchymal. Each of these subtypes then carries its own set of mutations, and multiple subtypes can be found in the same tumor. This results in a situation where current drugs can only target a small percentage of all the tumor cells.
Adding to the problems with glioblastoma and unlike all other cancers, the big question for glioblastoma patients is not what mutations the tumor contains, but rather where it is.
The major distinguishing trait of glioblastoma is that it is more or less inoperable. The glial cells it derives from are found in every part of the brain, and glioblastoma similarly penetrates throughout the brain. Unlike almost all other cancers where metastasis is the major cause of death, glioblastoma rarely spreads beyond the brain, and instead kills patients by suppressing vital neurological processes, such as regulating cardiac contractions or breathing.
Paralleling the severity of this cancer, treatments for glioblastoma have failed time and again, such as Celldex’s failure with Rintega. Meanwhile, those treatments that are currently approved for Gliblastoma aren’t even effective in prolonging overall survival. Only a few types of chemotherapy such as Temozolomide can slow progression of GBM. These factors combined make most medical treatment worthless, regardless of whether patients are on the cheapest Affordable Health Care plan or the super premium insurance carried by most senators. Indeed, little has changed from Obama’s inaugural address where Senator Ted Kennedy was diagnosed and soon died from glioblastoma up until Trump’s address.
However, among the things changing in the current political upheaval is the outlook for glioblastoma patients. This is directly the result of Novocure (NASDAQ:NVCR) and their recently approved therapy, Optune.
Optune’s description would better fit in an Isaac Asimov novel than in real scientific practice, but it has been proven effective for treating glioblastoma time and again. Rather than a drug, Optune is a collection of transducer arrays that are worn by the patient as a hat (See picture). These arrays rapidly alternate electric fields throughout the brain of the patient for 18 hours a day. The alternating electric fields shatter the DNA of unstable cells by attracting and separating molecules of different charges. In cells with many mutations, the cell division process is less stable and poorly regulated, making these alternating electric fields, or Tumor-Treating fields (TTFs), more effective at stopping glioblastoma growth.
For scientists working in the cancer field, this discovery came out of left field, and no one ever thought it would work, myself included. Yet, here we stand with Optune as the single most promising therapy for glioblastoma patients. While there have been many issues with understanding how Optune will be picked up by insurers and prescribed by doctors, its effectiveness combined with very limited side effects makes it one of the most exciting therapies of this decade. It is also extremely likely that John McCain will be prescribed an Optune device.
Beyond glioblastoma, Optune has incredible potential for treating cancers that metastasize to the brain. These include many common types such as breast, lung, and many blood cancers with clinical trials testing Optune for these cancers are currently underway. Meanwhile, a re-tooling of the device may make it effective for other highly unstable cancers, such as smoking-induced lung cancer. Despite its slow start, Novocure currently has limitless opportunity for expanding its treatment indications and patient pool.
