Even more importantly, what would all this do to Rhonda and our three children, all of them in their mid-20s? And where would I go for the necessary operation and follow-up treatment? I’ve always told my patients that they were at the right hospital when I saw them—did I really believe what I had said when it was MY NECK on the line?
Well, to make a long story short, I DID have my operation at M.D. Anderson. It went well with no deficits or problems. Then I received six weeks of radiotherapy to my brain—and thankfully, I was able to keep working as Medical Director of our M.D. Anderson physician practice plan, which covers about 664 staff physicians. Better yet, I kept riding my motorcycle to and from work—and everywhere else—starting seven days after my operation!
Now here’s where it got complicated. After the radiotherapy, I had to choose long-term therapy of some sort. Glioblastoma is notorious for sending small microscopic cells far into the surrounding brain. Without aggressive long-term therapy, there is almost a 100 percent chance of tumor recurrence, even with a good “apparently total” resection (removal) of the tumor. My therapy choices were to explore a relatively new vaccine therapy (immunotherapy) at M.D. Anderson and at Duke University Hospital or stay on conventional chemotherapy.
Well, being a typical pushy neurosurgeon, I asked, “Can I do both (chemotherapy and immunotherapy) at the same time?” The first answer was, “Well, no one has ever done that for a brain tumor.” But then Amy Heimberger, my neurosurgery colleague and the head of our tumor vaccine program, said that she and others were thinking about doing exactly that, based upon some small studies in mice. However, they couldn’t be sure it would work out okay in humans until it had been tried with at least one patient.
My answer: “Just think of me as a six-foot tall lab research rat and go for it. Let’s see if we can, each month, use the chemotherapy to depress (squelch) my immune system, and then give the vaccine injection when the immune system (white blood cells) start to rebound from chemotherapy. In that way, you can “supercharge” the bone marrow to make the immune system much more sensitized to attacking any tumor cells the immune system can find.
