Posted Thursday, September 4, 2008 by
Liza Ollila
Today you get a small break from my writing (at least in this post) because I want to share this article with you instead; it’s a short story about a nurse who experiences life as a patient when she is diagnosed with an aggressive brain tumor. I found this article interesting because I liked hearing the perspective of a nurse who is also patient. Those of you who are medical professionals will probably find it even more interesting. The article is courtesy of NurseConnect.com and if you want to see what other articles they have available, you can do so here.
Nurse Receives Investigational Brain Tumor Vaccine
By Debra Wood, RN, contributor at NurseConnect.com
For 32 years, Kathy Montag, RN, has cared for neuroscience patients, but one day in December 2007 the tables turned. She found herself in a patient bed recovering from a craniotomy to remove a glioblastoma multiforme—the most aggressive type of brain tumor—and in a fight for her life that includes an investigational vaccine made from her own tissue.
“I knew a diagnosis of a glioblastoma was 99.9 percent a death sentence,” said Montag, 53, a nurse and patient at Overlook Hospital in Summit, New Jersey. “When Dr. [Michael] Gruber told me [about the trial], I was all for it. I will take whatever I can do to live. I knew if I didn’t, this thing was going to kill me.”
Montag’s symptoms began in December with headaches, followed by nausea and vomiting. Her primary care physician thought it might be migraines and suggested a CT scan. Before she could schedule the outpatient procedure, however, Montag started feeling much worse. She called off work that Saturday and asked her husband to drive her to the hospital.
The CT technician knew her, immediately recognized a problem on the scan and paged a neurosurgeon to take a look. The physician told her she needed surgery and scheduled it for Monday, two days later.
“I was pretty scared,” Montag admitted. “I didn’t think it was good, rushing me in.”
Brian Beyerl, MD, operated and removed the tumor. He told her family it was a stage IV glioblastoma and warned she would have a real fight on her hands.
Montag recovered in the neuro ICU, followed by a stay on the neuroscience unit. She appreciated the great care her peers provided.
“It was hard on my co-workers,” Montag said. “I could hear people in the hall crying.”
Since her surgery, Montag has received three radiation treatments, and she continues to take Temodar chemotherapy, while participating in the phase II clinical trial for DCVax®-Brain, a dendritic cell immunotherapy vaccine.
Montag began receiving the vaccine, which is administered interdermally, in April,. She has experienced no side effects.
“The vaccine is trying to get my body to recognize the tumor as bad, get into gear, and if [the tumor] starts to regrow, to go after it,” Montag said. “They are highly aggressive tumors and have a high rate of regrowth.”
The trial is open to newly diagnosed patients with a glioblastoma. Surgeons must resect sufficient tumor to produce the vaccine. Patients are randomized to receive the active vaccine or a placebo. Both groups of participants are given 10 injections spaced at the same intervals.
Side effects may include inflammation at the administration site, fever and fatigue, itching, or an allergic reaction, said Pat Eagan, RN, clinical research coordinator at Overlook and the Brain Tumor Center of New Jersey. Overlook has enrolled three participants. None have experienced side effects.
“The biggest risk is that it doesn’t work,” Eagan said. “It’s not something we use as a last ditch effort. We’re offering it up front with the hope it will benefit, but we don’t know. It’s very early.”
The multi-center trial will measure progression-free survival from time of randomization and overall survival.
The vaccine maker, Northwest Biotherapeutics of Bethesda, Maryland, released results of the phase I trial earlier this year. At the end of 2007, median overall survival and the median time to disease progression were more than twice as long in the treatment cohort than in the group receiving the standard of care, which includes surgery, radiation and Temodar.
Eight of the 19 patients in the trial were still alive, and five showed no signs of cancer recurrence. At that time, 68 percent of patients receiving DCVax®-Brain in addition to standard of care had lived longer than two years, 42 percent had lived longer than three years, and 26 percent had lived longer than four years. The median overall survival time for standard of care patients is 17 months.
Montag hopes more patients will participate in clinical trials so investigators can obtain the additional funding needed to pioneer new treatments. She now talks to newly diagnosed patients about her experience and trials and how research contributes to advancing the science.
“People maybe have a year or two after diagnosis, but I need more time than that,” Montag said. “I have all these things I want to do.”
