R.I. neurosurgeon advancing brain tumor treatment
PROVIDENCE — Since relocating from Boston to Rhode Island in 2022, Dr. Athar N. Malik has been instrumental in advancing the state’s capacity to treat brain disease and injury. He’s introduced a new training program focusing on awake craniotomies at Rhode Island Hospital’s Norman Prince Neurosciences Institute for Brown University neurosurgery residents; is involved in new clinical trials; and he’s implanted Rhode Island Hospital’s first brain oxygen monitor, which is enabling personalized care for comatose patients.
Q. What is the Norman Prince Neurosciences Institute, and what kinds of services is the institute offering?
A. The Norman Prince Neurosciences Institute at Rhode Island Hospital is a national leader in the neurosciences that treats disorders of the brain and spine.
Q. You introduced a new training program that focuses on awake craniotomies. Why is this procedure so critical, and why do patients need to be awake?
A. If you take patients who have epilepsy or brain tumors, sometimes they need surgery in the part of the brain that controls language. The safest way to operate on that part of the brain is to have the patient awake during surgery, so that you can map out exactly where language is being processed, and parts that control motor skills, so that you seek to avoid certain areas. The purpose is to have a safe surgery as we’re approaching the brain lesion, to on awake craniotomies. It leads to better outcomes for patients.
Q. What is it like for the patient during an awake craniotomy? There aren’t any pain receptors in the brain, but is there a pinch or tightness that the patient might feel?
A. We do what we can to maximize patient comfort. They are sedated in the beginning and end of the surgery. That’s when you’re performing parts of the surgery that could be uncomfortable for the patient. But then, once the brain is exposed, all sedation is held. The patient is able to wake up, and there is not significant pain.
Q. What kinds of cuttingedge clinical trials are on the horizon at the institute?
A. We are now in the process of becoming a center for deep brain stimulation for stroke, which is a brand new clinical trial. We have a large number of clinical trials for brain tumor patients as well. One of the brain tumor clinical trials I’m involved in is the IMVAX IGV-001 Phase 2 clinical study, which aims to evaluate the safety and efficacy of a novel vaccine immunotherapy for patients with newly diagnosed glioblastoma.
Q. How could this new vaccine help patients with glioblastoma?
A. It involves immunotherapy, which means we’re using the patient’s own immune system to try to treat their tumor. So if a patient has newly diagnosed or newly suspected glioblastoma, then we remove their brain tumor, send that tumor to the central lab associated with the clinical trial, and that lab creates a custom drug for that patient’s own brain tumor. That drug is then put into small capsules, which we implant into the patient’s belly, which activates the immune system to target those patient-specific tumor cells. Those capsules are removed after a few days.
This current trial is being conducted at 20 sites across the US seeking to enroll 100 patients. We’re one of those sites, and we’re still enrolling patients.
What does the early data show for this new vaccine?
A. Early data suggests that this treatment improves outcomes with patients with glioblastoma since their immune system has been trained on what their tumor looks like and can help with clearing that tumor from the brain.
Q. What is the need, and what do you need to expand?
A. The need is really hard to gauge. I don’t know all the patients in the community that have these issues where treatments might help. The other challenging part is there are so many patients with issues — like refractory epilepsy — and they may not know, and their neurologists and other doctors may not know that there are treatments that exist right here at Rhode Island Hospital.
There are plenty of patients with essential tremor and Parkinson’s disease who don’t want surgery, and just continue on medication. But they don’t know that we have this phenomenal, non-invasive, MRI-guided and focused ultrasound treatment where they can come in, not have any incision, and leave the same day with improvements in their tremor.
Patients don’t know about these procedures, but many doctors don’t know they exist, either. You’re not taught this [about advanced capabilities in neurosurgery] in medical school — even if you want to go into neurosurgery. Right now, this is an issue of education and how we have to get the word out.