Head, Division of Neurosurgery, UBC/VGH; Assistant Professor, UBC, Department Surgery; Director, BrainCare BC, BC Cancer Agency

In previous posts, I have directly alluded to the future of cancer treatment and the repetitiveness of this topic, I believe, validates its existence and realistic potential. The future of cancer treatment in general has to do with personalized medicine and molecular or genetic analysis, like Dr. Aly Karsan talked about here last month.

The same holds true for brain cancer.

In the old days, a pathologist would look down a light microscope and describe a tumour based on its shape and colouration. From this, a name would be attached, a treatment plan assigned and a textbook prognosis delivered. To me, that is paramount to taking a group of teenagers—of different sizes, shapes and ethnicities— and purely based on physical appearance, try to predict where they will be and what they will be doing in 20 years. Surely the better way to predict this is by talking to them and seeing what’s inside their heads.

Similarly the next wave of cancer treatment involves not just better weapons, it equally involves using a better gun sight to clarify a better target—to not be satisfied by cell shape, but discovering the systems it uses to survive.

A better understanding of this tumour cell function will help. Consider the following: if Drug A was found to only help five per cent of patients, the drug company would quickly stop promoting it because it would never sell. Classical thinking wants to find the drug that helps 80 per cent of people. But if one could figure out which five per cent of patients responded to the drug—in other words, which tumours had biologic susceptibility to the drug—it is suddenly effective for 100 per cent of the select patient population.

We didn’t alter the drug, but it became exponentially more useful, because we narrowed the gun sight and found the best target. If you’re one of the five per cent, it is a Godsend. If you are one of the 95 per cent, you are spared a treatment destined to fail. Imagine all the drugs that have been discarded prior to this new strategy.

That’s exactly what molecular markers, biologic targets and genetic sequencing does. Please refer back to the brilliant blog posts of Dr. David Huntsman and Dr. Marco Marra for more details on these concepts.

Our strategy engages these same scientists to apply their creative minds and powerful tools to distill all the idiosyncrasies and peculiarities of brain cancers. Not just what the cells look like, but how they “tick.” We will apply this analysis to each individual patient’s tumour and to develop an individual treatment algorithm. With this knowledge, we can readily prescribe the right chemotherapeutic agent for a person’s tumour like we can prescribe the right antibiotic for a dental abscess.

Brian