Sunday, August 19, 2007

The Way Forward

I have been doing alot of thinking about how to insure I beat this thing. Here's what I think now.

First of all, I will of course first do the prudent things recommended by my physicians to get through the initial period -- conventional radiation and chemotherapy, to fight regrowth of the tumor from those parts that could not be surgically resected. This will buy some time to pursue more innovative and promising approaches.

But then I plan to drop my role as "patient," and take up the role of "scientist/engineer." I intend not only to personally survive this cancer, but I want my case to mark the dawn of a new era in treatment of glioblastomas, in which treatment is curative, not merely palliative. I plan to devote myself and my laboratory at Caltech to achieving this goal, working in close collaboration with my medical team, especially Dr. Igor Fineman, my fantastic neurosurgeon, and a top-notch research scientist himself.

So what is required to achieve this ambitious goal? Fundamentally, it is necessary to be able to selectively destroy tumor tissue, without attacking healthy brain tissue. For GBMs, this is hard, because they are formed from diverse tissue types, and physically intertwine with healthy tissue.

A very promising approach is to use heat to destroy the tumor, if heating agents can be selectively bound to the tumor. One way to do this is to use the body's own immune system, using T-cells that bind to the tumor, and that are also attached to small metal nanoparticles. The net effect is that the tumor can be selectively coated with nanoparticles. These nanoparticles can be heated with an external AC magnetic field, or by laser irradiation at their plasmon frequency (for gold, this is near 600 nm - red light).

In my group at Caltech, we have done quite a bit of work with gold nanoparticles as heaters for other applications (micro/nanostructure formation, fluid pumping in microchannels). But other groups are already using nanoparticles to heat and destroy malignant tumors. I would be very excited to shift our focus to using gold nanoparticles to selectively heat and destroy glioblastomas. I really think this approach may offer the first possibility of curative therapy -- that is, therapy that really gets all of the residual tumor, leaving nothing for further growth!

For this reason, I not only expect to eventually be cured of this GBM, but I expect this will increasingly be the norm! We will go from the present situation, in which survival is measured in months, to one in which patients live many years, and ultimately die of something else. I see no reason to think this cannot happen - it can, should, and (given enough resources and smart people) will happen!

Back in Shingle Springs

We're back home after spending a week with Dave, Frances, Tim and Erica. We didn't get what we had so fervently hoped for, a benign tumor, but we are thankful Dave came through the surgery so well. He amazed us with how rapidly he was back to being himself and was even released from the hospital a day early! I think one of our main task now may be to keep him from doing too much too soon. He is gung-ho to defeat this thing.

Frances has been working in every way to get things done quickly for Dave and by the best people. They will both be doing research and seeking out available treatments and programs. They are a good team with their different scientific backgrounds. We are so grateful Dave has Frances by his side.

Even though there was some sadness in this trip, we enjoyed long talks with Dave about the past, present and future. In addition to some tears, we had many laughs. Of course, we have a long history together so we never lack for something to talk or joke about. We loved being with Dave and his family and look forward with confidence.