Big Things Happen in Small Places

His enthusiasm is infectious.  The twenty some faces around the conference table at Swedish’s Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, focused on Dr. Greg Foltz, tracking every word this talented neurosurgeon and leading research scientist shared as he brought us on his journey to cure brain cancer.  He began by asking how many of us knew someone who had or has brain cancer.  Every hand went up.   Some, like me, may have a friend currently in her battle for time against this (currently) unstoppable killer.  Others, like my dear friend who was not there, the trauma still too close at hand to expose herself, may have lost a precious child to its insidious onslaught.  At the table were my friends Sharon and Brian whose son is currently in its grip, now nearing his fourth year in battle for more time against this always unbeatable foe.  The hit rate of those at the table who knew someone in a battle with brain cancer was 100%.  Yet, as Dr. Foltz explained, there are only about 20,000 new cases yearly diagnosed in the US.  And this has been the biggest part of the problem.  When you know so many people touched personally by it, 20,000 seems a big enough problem.  But, in the world of cancer, or other major medical problems, that’s not enough to warrant the research dollars or motivate major pharmaceutical companies to find a cure.  Thankfully, it’s enough to warrant the dedication of Dr. Foltz, and a handful of other doctors and scientists at other centers around the country, towards finding the cause and finding a cure (actually cures) so that someday he can tell a patient “here’s how we can save your life.” 

On this day, our group is privileged to receive an approximately hour-and-a-half tour of the Ivy Center and labs.  Dr. Foltz, after a full day, including doing surgery on a patient, meeting with patients and conducting research in the lab conducts the whole thing.  He starts with a presentation on the history of brain cancer treatment and research in the conference room.  This is followed by a walk through the Ivy Center with a discussion about Ben and Catherine Ivy and the services the Center offers.  Then we are walked through the back side of the center (it is after hours) and into the small labs where exciting things in the advancement of treatment are happening.  Here is what we learned and saw.

Just four years ago the only thing to tell patients receiving the diagnosis of glioblastoma, the most common – and aggressive - form of brain cancer, was that they needed to prepare for a short battle, for which they would have only a dismal arsenal of weapons to defend themselves and against which they would surely lose.  Probably six months would be the longest they could hope for, and only if they had found the enemy early.  Now, with advances in surgery and radiation and chemotherapy, some patients are sharing up to four more years with their families. There are even a few five-year survivors now.  And finally it looks like soon a newly diagnosed patient may hear these words “this is what we can do to likely save your life.”

Not only are Dr. Foltz and his peers hopeful that there will soon be ultimate winners in this battle, but that that they can greatly increase the quality of life for these troops during battle.  They’ll do this by identifying specific protocol for each patient, depending on their particular cancer’s genetic markers, so that harsh side effects from treatment are reduced or eliminated.  

 In the fascinating presentation Dr. Foltz compared the progress in finding a cure for glioblastoma which, until now, has been labeled as “incurable” to “consumption” at the turn of the Century, or more recently, leukemia: both of which were also once labeled incurable.  Consumption is something nobody worries about, yet at one time it wiped out a third of the European population.  When I was a little girl I remember hearing of other children getting leukemia and knowing that it was fatal.  Yet today it’s almost a relief if a cancer is diagnosed as leukemia because it is known as curable.  Soon, it is hoped, a glioblastoma diagnosis will be equally curable as leukemia.  And maybe one day, like consumption, no longer even something anyone has to deal with. 

The presentation included an overview on progress in identifying genetic markers for specific cancer cells, and a fascinating discussion on why pharmaceutical companies are not focusing on identifying a cure (basically too few patients mean too little profit).  Dr. Foltz and his colleagues have found ways to use research focused on other problems to solve this one. His story included a tale of a mouse that has been “invented” that has no immune properties of its own so they can “infect” mice with a patient’s specific cancer cells (removed during tumor surgery then grown in a lab) and then test the impact of various drugs and dosages on that cancer so as to determine a specific approach for that patient. 

Rather than focus on creating a new cure, they are finding that drugs already developed to help patients with other seemingly unrelated problems, like depression, seem to carry some key to confronting glioblastoma.  Dr. Foltz had a wonderful way of presenting this highly scientific focused subject matter at a level that was not only easy to follow but also interesting.  He explained a major focus of his approach to find a cure was like something many of us experience with shopping on “Amazon.com.”  The analogy is tied to the phenomenon whereby just one interaction on the site provides enough information to be compared with the millions of other shoppers and their purchasing history that by the time you go to the checkout screen, the website can recommend dozens of other items that you are likely to also be interested in.  This analogy emphasizes how important tissue data banks coupled with a history of the response to different types of treatment will increase the chances of finding the best approach to tackling a patient’s particular cancer. 

Then we were taken on a tour of the labs where all this groundbreaking work is going on. Although it was after hours and the lab workers were gone, in this surprisingly small space, the machines were working on: sorting out genetic markers; growing cancer cells in vials that could be harvested later to test treatments; and infusing cells with cancer fighting agents in order to create vaccines. 

While much of the presentation and tour included the simplified explanation of scientific approach, Dr. Foltz also emphasized how important the individual’s experience is.  How huge the impact to family is.  How important it is to involve the larger community as well.  I admired his openness to working closely with the patient and their family in doing what is right in their own situation regardless of what trials may be currently de-rigueur.  How quality of life is important while the scientific battle often focuses more on extending the quantity of life.  The Ivy Center provides support to the patient and family in dealing with the impacts to their lives, while the scientists and doctors deal more directly with the cancer itself. 

In addition, the Ivy Center was carefully planned to encompass patients’ needs, beginning with the Center’s lobby design. It contains many alcoves and partial walls to allow families privacy and community while waiting and then receiving news from surgeons.  The exam and treatment rooms include seating spaces for supporting family members, rather than relegating them to standing in the corner as other places oft do. 

Dr. Foltz believes that the cure for many cases of brain cancer is likely to already be in existence, or similar to something that is, and may be very close.  While a new lab will be opened soon at the Ivy Center, Dr. Foltz and his team are not waiting.  They are doing remarkable things with the equipment they have, coordinating with other research centers, and giving hope to the families and friends of brain cancer patients.
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Note: I first visited the Ivy Center in 2009.  Here is a link to that post.  Amazing to see all that has happened since then.