Miami Herald (Sunday)

Fatal brain cancer survivor sparks hope for treatment

- BY MEREDITH COHN The Baltimore Sun

BALTIMORE

The brain cancer diagnosis was so grim for Rick Miller that he says a social worker told him to “get my affairs in order.” Glioblasto­mas typically kill people in about 12 to 15 months.

But that was not the end of Miller’s journey. He and his wife, Diana, took a trip from their Eastern Shore home to the University of Maryland Medical Center in Baltimore to hear other options and signed up for a clinical trial.

That was three years ago.

Miller, 65, isn’t just alive. There is no sign of cancer, and he’s getting back to his boat maintenanc­e business. Two months ago, he and Diana traveled to their son’s wedding in Florida.

“It worked,” declared a smiling Miller, standing in front of his next boat project, his own 40-footer, at his property near Chestertow­n.

His doctors can’t say he’s cured, nor guarantee the cancer won’t return or even yet officially credit the treatment he received in the clinical trial for his life and health. But, they say, he and most of the 14 people who participat­ed in the initial study are alive. After years with little progress in discoverin­g new treatments for glioblasto­mas, they are in the unusual position of having hope.

Glioblasto­mas are the kind of brain cancer that killed U.S. Sens. Ted Kennedy and John McCain and President Joe Biden’s son Beau. They are normally treated with surgery, chemothera­py and radiation, but the tumors almost always come back. Federal figures show about 14,000 people a year are diagnosed in the United States, but as few as 5% survive five years, according to the Glioblasto­ma Foundation.

The foundation cites the method used on Miller, focused ultrasound, as one of only a few avenues of promising research. Others include repurposin­g older drugs and earlier detection.

Miller was receiving standard care when he entered the Phase 1 trial. Such trials are intended to assess safety and show whether a process works. Surgeons on the Eastern Shore already had removed a large, late-stage tumor from the right side of Miller’s brain in 2019.

At the Baltimore hospital, neurosurge­on Dr. Graeme F. Woodworth and medical staff secured Miller’s head with a metal halo and screws. They put him in a magnetic resonance imaging, or MRI, machine and injected a bubbling agent into his arm. Then they used ultrasound, or high-frequency sound waves, to guide the tiny bubbles to the precise site and shape of the tumor.

Woodworth watched images from the MRI on a computer screen from a control room as the commotion from the bubbles created temporary leaks in the protective layer around the brain known as the blood-brain barrier. The barrier of cells and blood vessels normally protects the brain from toxins, but it also blocks helpful therapeuti­cs.

The openings lasted hours, long enough for Miller to return home and follow separate instructio­ns from his cancer doctors for taking standard chemothera­py pills.

He returned monthly for more focused ultrasound treatments.

Woodworth has not yet submitted findings in a peer-reviewed journal, but he is working with pharmaceut­ical leaders and seeking funding for more and bigger trials to learn more about the efficacy of the technique and get it approved by the U.S. Food and Drug Administra­tion for wider use. They also are working to determine whether there are more effective drugs generally or that help people with different types of glioblasto­mas.

“All we can say now is that we did it safely,” said Woodworth, also a professor and chair of neurosurge­ry in Maryland’s School of Medicine. “Today, it feels promising. But we need more proof.”

Already doctors have refined the process of shaping the opening to the tumor site and eliminated that immobilizi­ng metal halo, which Miller called the worst part of the trial.

Focused ultrasound is a growing area of research, with more than a dozen companies investing nearly $400 million last year to potentiall­y deliver better treatment for multiple kinds of cancers, not all in the brain, according to the Focused Ultrasound Foundation.

Woodworth is working with an Israeli medical device company, Insightec Ltd., that developed the tools for the procedure.

Three years in, the Millers couldn’t be more pleased with the results, whether they’re due to the trial, really successful surgery or his general good health before his cancer diagnosis.

The absence of Miller’s cancer has been confirmed in regular scans by Dr. Mark Mishra, University of Maryland School of Medicine’s director of clinical research and associate director for the hospital system’s cancer network. He presented the trial option to the couple.

“As soon as I mentioned it, they were both very interested and were among the first enrolled,” Mishra said about Miller and his wife, who is a nurse. “He stands out because he’s done so well. He’s not had any recurrence, but more importantl­y, he’s maintained his quality of life and is getting back out and doing things he used to do before his cancer diagnosis.”

Mishra noted the “tough talks” they had before the treatment about the diagnosis and the rarity of long-term survival. Now, he said, “Mr. Miller’s case shouldn’t be a unique one, and the only way to raise that bar is through clinical trials.”

He said they will happen at Maryland, other universiti­es and the National Institutes of Health, and doctors will look at different types of drugs for new or recurrent tumors, as well as for different subtypes of glioblasto­mas. Because there can be different molecular features at different stages in different patients, they may be treated uniquely in the future, in a move toward personaliz­ed, or precision, medicine.

Diana and Rick Miller are glad for the research, though they hope Rick never needs another trial.

 ?? JERRY JACKSON TNS ?? Boat mechanic Rick Miller was diagnosed with a deadly brain tumor called a glioblasto­ma. He participat­ed in a clinical trial trial three years ago using focused ultrasound to allow chemothera­py to penetrate the blood-brain barrier.
JERRY JACKSON TNS Boat mechanic Rick Miller was diagnosed with a deadly brain tumor called a glioblasto­ma. He participat­ed in a clinical trial trial three years ago using focused ultrasound to allow chemothera­py to penetrate the blood-brain barrier.

Newspapers in English

Newspapers from United States