A neuro-oncologist at the Brain and Spine Tumor Center at NYU Langone Health’s Perlmutter Cancer Center, Sylvia C. Kurz, MD, PhD, treats people who have brain tumors and cancer, as well as people who have immunotherapy-related side effects or pain resulting from cancer treatment–related nerve damage.
Dr. Kurz, assistant professor in the Departments of Medicine and Neurology and interim director of the Neuro-Oncology Program at Perlmutter Cancer Center, conducts translational and clinical research on brain tumors and is a co-investigator on various clinical trials, including several immunotherapy trials. In addition, her research focuses on developing new and more effective treatment options for people with progressive and therapy-resistant intracranial meningiomas. To this end, she is the co-chair of a clinical trial spearheaded and led by Perlmutter Cancer Center investigators that investigates a novel radionuclide therapy for advanced meningiomas.
She discusses how clinical trials are testing new treatments for people with hard-to-treat brain tumors such as meningioma and glioblastoma, a promising treatment for people with brain metastases, and more.
You are conducting several clinical trials for people with brain tumors. Are there any that you are particularly excited about?
I am most excited about a clinical trial that has been developed out of a multidisciplinary effort at Perlmutter Cancer Center that investigates the efficacy of a radionuclide therapy called Lutathera®. This drug is promising to treat people with progressive intracranial meningiomas. Meningiomas are often benign tumors, and most people don't think about them as cancers. However, a subset of tumors can be aggressive or progress to a more aggressive type of meningioma. In these cases, their treatment options are limited and not very effective. This study fills a vital gap as there are few clinical trials available for people with advanced meningiomas. This is one of the most popular clinical trials that we offer currently, and we attract patients from outside and inside NYU Langone to participate in this trial.
In this study, we are investigating a novel way of treating meningiomas. Instead of using a chemotherapy drug or a manufactured chemical agent, we are using a so-called radionuclide-linked antibody, 177Lutetium-DOTATATE, or Lutathera®, that targets a receptor is expressed in approximately 95 percent of all meningiomas. Because the radioactive substance is attached to the antibody, it can be delivered very locally and only to the cells that bind to that antibody.
We launched the study last year, and we've now enrolled 12 patients. We’ve had the first group of patients complete the protocol of four doses of the treatment and now we're entering the surveillance stage. Half of the patients have finished all the treatments, the others are still going through the treatments. What we have seen is that there are certainly patients whose tumor progression is halted on the study.
Another important and popular clinical trial is our study of a drug called ONC201 to treat a special type of high-grade glioma that is characterized by a histone K27M mutation. This study has attracted patients from all over the world to come to Perlmutter Cancer Center.
You also treat people with treatment-related brain and nerve damage. Can you tell us about your success with these patients?
Anecdotally, I can share my excitement in treating a patient with advanced HER2-positive breast cancer whom I share with Sylvia Adams, MD, professor of medicine and director of the Breast Cancer Center at Perlmutter Cancer Center.
This patient developed a condition in which the cancer had spread to the skin-like layers around the brain and spinal cord, called progressive leptomeningeal disease, in May of this year that led to starting a drug called Enhertu®. Against all expectations—patients with leptomeningeal disease usually have a poor prognosis—she now demonstrates improvement in leg strength and sensation as well as improvement seen on MRI scans.
In May, she couldn't walk and had no control over her bowel and bladder. Now, four months later, she can move her leg and walk with assistance of a walker. While this is only a single case, I'm excited about the potential of Enhertu®, especially in patients with brain or leptomeningeal metastases from HER2-positive breast cancer.
What do you tell patients who come to you for treatment for meningioma and glioblastoma, which typically have limited treatment options?
For glioblastoma there is no effective treatment after first-line therapy consisting of surgery, radiation, and chemotherapy. However, patients can participate in clinical trials and receive promising novel therapies. Many patients appreciate this option because it gives them the sense that something is being tried, even if we cannot guarantee that a course of treatment is going to work in their particular case. We give them the benefit of the doubt and this may give them hope.
Many meningiomas can be treated successfully by tumor resection and radiation. However, a few patients progress despite repeated surgeries and courses of radiation. In these cases, medical treatment options unfortunately remain very limited. It is important in these cases to design clinical trials and enroll patients so that we learn more and develop more promising treatment options. This is one of the biggest areas of need in neuro-oncology.
In terms of how to tell patients when there are only limited or no more treatment options left, I think it is important to stress the point that even if we only provide symptom control and comfort measures, there is always something left that can be done to possibly improve quality of life, reduce pain, or alleviate anxiety. It is important for patients to not feel abandoned just because there are no more treatment options. Instead, they need even more help and support during this difficult time. This can only be accomplished with a multidisciplinary team approach.
At any decision point, we therefore offer patients the most comprehensive review possible and review the case with colleagues from neurosurgery, radiation oncology, pathology, palliative care/supportive oncology, and psychology. Patients want to know that the team has thought about any and all options, even if the result is that more tumor-direct treatments are likely not going to be successful anymore. That helps them understand and accept a focus on supportive care, when appropriate.
In other cases, there may be an option that, while it may not be able to cure the particular type of tumor, may at least slow down tumor progression. In a field like neuro-oncology where many tumors cannot be cured this is still a meaningful outcome. In these cases, it is important to weigh the side effects and burden of therapies against the potential improvement in neurological symptoms and quality of life. And, by weighing the risks against the potential benefits, make a decision together with the patient if it is worth trying this.