The Academy

By Prachi Petal-Predd
Published: Monday, Jun 21, 2010
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Novel Mapping Technique Has Potential to Improve Brain Surgery

In a clinical discovery likely to enhance understanding of human brain function and have profound implications on brain cancer surgery, neurosurgeons from the University of California, San Francisco (UCSF), are reporting that they have derived significant results from a new brain mapping technique. The advance allows for the safe removal of tumors near language pathways in the brain, minimizes brain exposure, and reduces the amount of time that a patient must be awake during surgery.

Significantly, the study, which appeared in a recent issue of the New England Journal of Medicine, provides new data that yields an increased level of insight into brain mechanics, refining scientists' understanding of how language is organized within the human cortex.

First, the researchers identified new cerebral regions involved in speech production, reading, and naming. The study team then applied these data, utilizing them to generate a three-dimensional cortical language map that, according to UCSF researchers, is more detailed and integrates more data than any language map of the brain ever generated.

According to senior author Mitchel Berger, MD, professor and chairman of the UCSF Department of Neurological Surgery and director of the UCSF Brain Tumor Research Center, “This study represents a paradigm shift in language mapping during brain tumor resection. Not only have we proven this technique can be safely relied upon for brain tumor resection, we have shown functional language organization to be much more diverse and individualized than previously thought.”

According to the study’s lead author Nader Sanai, MD, senior resident in neurological surgery at UCSF, the utility of the findings are likely to extend beyond brain cancer surgery. “Accurately understanding cortical language organization has clinical implications for more than just brain tumor patients. Any patient with a seizure disorder, stroke or head injury who has language-related difficulties can now be better understood in the context of this revised anatomy,” he explained.


Combination of Taxol and Avastin Yields Robust Results for Breast Cancer

A study that its researchers are touting as first to demonstrate that an antiangiogenic agent can delay progression of advanced breast cancer was recently published in the New England Journal of Medicine. The study, an open-label, randomized, phase III trial, coordinated by the Eastern Cooperative Oncology Group (ECOG) and Kathy Miller, MD, associate professor of medicine and Sheila D. Ward Scholar at the Indiana University School of Medicine and a researcher at the Indiana University Simon Cancer Center, Indianapolis, Indiana, looked at Taxol (paclitaxel), which is one of the standard agents for metastatic disease, with and without the addition of Avastin (bevacizumab).

According to Dr. Miller, also the study’s lead author, the cohort that received Avastin showed the biggest improvement in metastatic breast cancer ever reported in a chemotherapy-based clinical trial. It nearly doubled the time between initiation of chemotherapy for metastatic disease and progression of the breast cancer tumors.

“This study not only achieved the longest progression-free survival in advanced disease but the therapy achieved that improvement without adding to the day-to-day treatment burden and with only minor increases in toxicity,” said Dr. Miller.

The study enrolled 722 women with metastatic disease from the United States, Canada, Peru, and South Africa. Patients were randomized to one of two arms of the phase III study —Taxol alone or Taxol with Avastin. Patients were randomly assigned to receive 90 mg of paclitaxel per square meter of body-surface area on days 1, 8, and 15 every four weeks, either alone or with 10 mg of bevacizumab per kilogram of body weight on days 1 and 15. The patients, who joined the study from December 2001 through May 2004, represented a balance of age, disease-free interval, estrogen-positive receptors, and sites of disease. The primary end point was progression-free survival.

The results show that treatment with Taxol and Avastin increased the period patients went without progression of their disease from 5.9 months to 11.8 months (P < 0.001). The combination therapy regimen also increased the objective response rate, when compared with patients who received Taxol monotherapy (36.9% vs. 21.2%, P < 0.001).

“The next step is to move Avastin into the initial treatment of breast cancer in hopes that it will prevent recurrence in the first place,” said Dr. Miller.

Avastin is a human monoclonal antibody that acts to reduce the development of blood vessels that feed tumors. Cancer tumors need an increasing supply of blood to grow and the development of the blood vessels to supply the tumor is a process called angiogenesis. Avastin already has been approved by the FDA for treatment of colorectal and lung cancer.


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