Chemo wafers helping brain cancer patients live a better life
The wafers are placed in the tumor cavity, getting treatment to the site quicker.
By EMILY NIPPS
Published March 4, 2007
The first time Woody Izandick learned he had a brain tumor, he hoped for recovery and a long life. When the grape-sized tumor was removed and then returned even larger less than a year later, his outlook was a little less ambitious.
"Basically, I just didn't want to die before my son finished high school," he said.
A thriving, active life after a second bout of brain cancer is far from common. Yet seven years after Izandick's second surgery, the 52-year-old former active-duty military employee is not only about to watch his 22- and 26-year-old children graduate from college, but he still works out regularly and has a part-time job.
What made that second surgery so successful? Izandick believes it was the dime-sized Gliadel Wafers, which contain chemotherapy that dissolves right onto the site of the tumor cavity after surgery and immediately fights the growth of new cancer cells.
Approved by the Food and Drug Administration for use on recurrent brain tumors in 1996 and then on new tumors in 2003, the wafers are being hailed as somewhat of a miracle drug for what is considered one of the most aggressive forms of cancer.
"It's a very treacherous disease," said Dr. Sajeel Chowdhary, a neuro-oncologist at Tampa's H. Lee Moffitt Cancer Center who treats Izandick. "Such a breakthrough, in the general world of cancers, is quite profound. It's a very novel idea, a very interesting concept."
The wafers are becoming more and more commonly used in cancer research centers such as Moffitt and slowly making their way to community hospitals, as many doctors come to believe they are easier on the body than traditional chemotherapy treatment.
Because carmustine, the type of chemotherapy used to treat brain tumors, has typically been administered intravenously, its trek through the bloodstream has been known to cause side effects such as hair loss, weakness and damage to white blood cells and tissue.
With up to eight Gliadel Wafers being placed directly on the site of the removed tumor, side effects are less common, Chowdhary said. Another benefit is that the patient can receive chemotherapy right away, instead of waiting the typical two weeks for post-surgery healing to begin IV chemo and radiation. The wafers dissolve within two to three weeks and are most likely followed by other types of treatment, depending on the size and severity of the tumor.
In Izandick's case, he supplemented the wafers with 18 months of Temodar pills, another form of chemotherapy which he took five days out of each month. "I didn't really have a lot of residual effects," Izandick said. "I had a couple days out of every month that I felt nauseous. I worked that whole time, missing maybe one day a week."
His success is not necessarily typical. Studies have shown that on patients with recurrent tumors, Gliadel Wafer treatment adds an average of 2.6 months to their lives.
"For you and I, that must seem like a small amount of time," Chowdhary said. "But even a benefit of two months is a good amount of time to someone with brain cancer." He added that new research is expected to be out soon and will likely show a longer survival span.
Izandick, who lives in Satellite Beach with his wife, Jane, returns to Moffitt every three to four months for an MRI. So far, he has not shown any signs of tumor regrowth.
"My guess is the longer you go, the better off you are," he said.
Those kinds of survival stories are becoming more common, Chowdhary said, and new developments like the Gliadel Wafers make him more optimistic with brain cancer patients.
"If you pass the two-year mark, you're considered a survivor," Chowdhary said. "We do have a good amount of sadness. I would say about 10 to 20 percent of high-grade glioma tumor patients have an outcome like Woody's."
Emily Nipps can be reached at (813) 269-5313 or nipps@sptimes.com.What is a Gliadel Wafer?
It is a thin, dime-sized biodegradable wafer that is saturated with the chemotherapy drug carmustine (also known as BCNU). Up to eight wafers can be placed in the surgical cavity left by brain tumor removal, and they dissolve over a period of two to three weeks, releasing chemicals directly on the site. The wafers are used in conjunction with other methods of treatment, such as chemotherapy pills and radiation.
What makes it more effective than the more traditional intravenous chemotherapy?
Some studies on animals have shown that the brain can receive 1,500 times the amount of chemotherapy from the wafers than with methods such intravenous chemotherapy, H. Lee Moffitt Cancer Center's Dr. Sajeel Chowdhary said. Also, patients can receive chemotherapy immediately after surgery with the wafer treatment, as opposed to the two to three weeks of healing required before IV chemo and radiation.
Are there any downsides to the wafers?
Critics of the Gliadel Wafer claim that it can cause serious side effects such as infection in the surgical cavity and seizures. Some patients could be allergic to carmustine, making them ineligible for wafer treatment.
Could the wafers be used on other types of cancer?
The Food and Drug Administration has approved the Gliadel Wafer for malignant gliomas, or brain tumors, only. However, Chowdhary said, carmustine has been effective for treating a variety of lung, ovarian and skin cancers, and researchers are interested in exploring more possibilities.