Thursday is the funeral in Phoenix, Arizona, for US Senator John McCain, whose remains are being transferred to the nation's capital for a public Friday Friday and procession and services on Saturday – a week after his death at the age of 81.
It was glioblastoma, an insidious type of brain tumor that is hard to eradicate, killing McCain – which cost five and a half years in a North Vietnamese prison camp and a fight against melanoma.
Cancer claims the lives of 600,000 Americans a year, says Duane Mitchell, a professor of neurosurgery at the University of Florida, in an article on glioblastoma published this week in The Conversation, a non-profit news source
In East -Pennsylvania every year 40 to 60 Lehigh Valley Health Network patients are diagnosed with glioblastoma ̵
The healthcare network, parent of eight Lehigh Valley Hospital campuses, offers new approaches that doctors hope will provide an improved prognosis for those who struggle against this type of tumor.
"Glioblastoma is one of the cancers we have not made much progress on in the past generation," Dr. P. Mark Li, LVHN Chief of Neurological Surgery, in an interview Wednesday with lehighvalleylive.com
"We have not done a very good job at improving survival in glioblastoma and the treatment is still a very general one, which means that it is still a common chemo that attacks growing cells, "he continued.
However, it is not for lack of experimentation and innovation. Glioblastoma was the first cancer to undergo a comprehensive genetic analysis as part of the Cancer Genome Analysis of the National Cancer Institute, Mitchell in The Conversation.
Researchers have found that the glioblastoma tumors of different patients may look similar in appearance. Englisch: bio-pro.de/en/region/stern/magazine/…2/index.html Tumors vary widely, with different mutations in the DNA code and different pathways that drive tumor growth, said Mitchell.
Then there is the invasive nature of the disease: glioblastoma or GBM, tumor cells "essentially creep away from the main tumor mass and embed themselves deep into the normal brain, often hidden behind a protective barrier known in the blood brain barrier," says Mitchell. "This invasive feature means that neurosurgeons can often remove the central major tumor mass of a GBM, but invade invasive finger-like projections into other areas of the brain, and the distant islands of tumor cells that have migrated away can not be effectively removed by surgery."  Glioblastomas also create their own blood supply, which helps them grow quickly and spread quickly.
"That's why surgery alone is never curative, radiation alone is never curative," Dr. Tara Morrison, director of neuro-oncology at Lehigh Valley Health Network, in an interview Wednesday. "Chemotherapy helps, but inevitably somehow we somehow miss a cell somewhere or one or the other cell is resistant and comes back.
" We're trying to find better ways to address it … but so far, nothing was 100 percent.
Here are four new approaches to combating glioblastoma:
Immunotherapy with Modified Common Cold Virus
The Lehigh Valley Hospital at Cedar Crest in the municipality of Salisbury is the only hospital in the region to attend a clinical study called CAPTIVE after LVHN
Participating patients facing recurrent glioblastoma receive an injection of a modified cold virus, called adenovirus, into the tumor, whereby the specially programmed virus replicates the tumor cells, infecting and killing healthy cells alone
"The adenovirus has been modified to replicate only in tumors with a defective retinoblastoma gene, which is almost always defective on glioblastomas," says Morrison in an LVHN profile
Patients also receive Keytruda infusions (Pembrolizumab) to stimulate the immune system to kill more cancer cells.  The clinical trial, which has been running for a year, has yet to draw a patient from the Lehigh Valley Health Network, Morrison said.
"We could not pick anyone from the Lehigh Valley simply because of the very strict criteria that the process has to make sure we do it safely while we figure out if it works that way," she said.
First of all, it is only available to patients over the age of 18, although glioblastoma affects pediatric patients.
"This tumor in children is almost considered worse than this tumor in an adult" The average survival for glioblastoma patients is 18 months and 12 months in patients over 70 years.
Like McCain, glioblastoma also claimed the lives of US Sen. Edward "Ted" Kennedy, D-Mass., At the age of 77 in 2009, and Beau Biden in 2015. The Iraq war veteran, Delaware's Attorney General and son of former Vice President Joe Biden was 46 years old.
It is unclear how CAPTIVE patients have acted because the sponsors of the study, the biotechnology company DNAtrix Therapeutics and Merck, have not published any data to the public, Morrison said.
"We understand from the sponsors of the study that they expect to close in the next few months due to success in other locations," she said Wednesday.
Another method of immunotherapy
LVHN Glioblastoma patients also have what is known as anti-PD-1 immunotherapy, which according to the network "slows down the immune system so that the body can clear cancer cells ".
In a trial those with a specific genetic predisposition marker (MGMT promoter methylation) will be randomized to standard chemotherapy (temozolomide), radiation and anti-PD-1 immunotherapy infusions against temozolomide and radiation, but no immunotherapy, according to LVHN received. Those without MGMT promoter methylation are randomized to receive radiation and immunotherapy against radiation and temozolomide.
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Immunotherapy has shown promise in the treatment of stage 4 lung cancer and melanoma, a deadly form of skin cancer.
Doctors are waiting for extensive evidence before fully accepting the promise of immunotherapy for the treatment of glioblastoma, said LVHN's Li.
"At the moment, these studies are very small and we are currently in safety and efficacy phase of the study, "said Li." We have some tantalizing accounts of patients who have had a very significant regression of their tumors or longer than expected survival, but these are isolated, small series or individualized reports and obviously we need much more Records to get really safe conclusions. "
Optune, formerly the NovoTFF medical device, received regulatory approval from the US Food and Drug Administration (FDA) in October 2015, according to the Lehigh Valley Health Network.
The device was worn clean the shaved head, creating an electric field that interrupts molecules to prevent the division of cancer cells.
With the use of Optune, the five-year survival rate for glioblastoma patients has risen from 8 percent to 13 percent, Morrison said.
"The definition of 'hitting' has changed," she said. "So only 13 patients make it five years and even that is not considered" cured. " I had some patients nine to ten years ago and it's coming back.
Neuro-oncological surgeons have also found success in the targeted treatment of glioblastoma tumors with a new FDA approval
It is injected into the patient's bloodstream while he or she is under anesthesia during surgery, and it raises tumor tissue to better distinguish it from healthy brain matter, he said.
"I believe that will prevail over the next few years. "
LVHN says it is a member of the MSK Cancer Alliance, which provides access to clinical trials as physicians specifically trained in all aspects of brain tumors.
" The main thing is that I want the public to know that we have a dedicated team of brain tumors that adopts a multidisciplinary approach in the treatment of glioblastomas and other brain tumors and that they were dedicated to every aspect of patient care, from diagnosis until the end of life, "said Morrison.
The Associated Press contributed to this report.
Kurt Bresswein can be reached at firstname.lastname@example.org. Follow him on Twitter @ KurtBresswein and Facebook Find lehighvalleylive.com on Facebook.