Treatment options for tumors that spread to the brain from primary cancers like lung or melanoma have improved a lot over the past two decades, thanks to advances in surgery, radiation, immunotherapy, and targeted therapy.
Unfortunately, the standard of care for glioblastoma, the most aggressive form of primary brain cancer, hasn’t kept up.
Dartmouth Cancer Center (DCC) neurosurgeon Linton T. Evans, MD, is changing that. In a newly opened clinical trial, Evans is studying a novel Dartmouth-designed fluorescent dye that sharpens the contrast between tumor and healthy brain, helping surgeons remove more cancer while preserving function.
“It’s very exciting moving a molecule that was developed at Dartmouth from preclinical conception to patients,” he says.
In this video Q&A, Evans talks about the eligibility, benefits and safety precautions of this trial, common questions from patients, and what motivates this Vermont native most about caring for patients with brain tumors at DCC.
Q: What is this new glioblastoma clinical trial studying, and why is it important?
Evans: When patients are diagnosed with glioblastoma, surgery is often the first step in treatment. One of the biggest challenges neurosurgeons face is removing as much tumor as possible while protecting healthy brain tissue that controls important functions such as speech, movement and memory.
This clinical trial is evaluating a new fluorescence-guided surgery technology developed at Dartmouth. Patients receive a fluorescent compound before surgery that causes tumor cells to glow under specialized lighting in the operating room. This contrast helps surgeons better distinguish tumor from normal brain tissue so that we can remove as much of the tumor as we can without causing any harm to the patient and ultimately give a better surgery.
Q: Who is eligible for the trial, and what does participation involve?
Evans: The trial is designed for patients who have been newly diagnosed with a high-grade glioma or glioblastoma and are preparing to have surgery. One of the unique aspects of the trial is that it does not require additional travel for any other study visits. This is especially important for patients who live in a rural setting or travel hours to come to DHMC. Because the study focuses on fluorescence during tumor removal, participation takes place all at the time of surgery. Patients continue receiving their standard care after surgery and can often have radiation or chemotherapy at a DCC location closer to home.
Q: What are the potential benefits of participating in the trial?
Evans: Many of my patients are motivated by the opportunity to contribute to future advances in treatment. And certainly the information that we learn from this clinical trial is going to have a direct impact on our understanding of this treatment and our ability to offer it more broadly to patients with glioblastoma in the future.
But participation may also provide benefits during treatment. Patients enrolled in clinical trials receive support not only from their clinical care team but from an extra dedicated research staff who closely monitor their care. Even when they move into standard treatment and aren't still getting treatment as part of the clinical trial, they are still followed by all of these providers.
One of the benefits I tell patients about being in a clinical trial is it just opens up the number of people that are keeping a close eye on you. Our patients already have a large, dedicated care team, but this just adds an extra set of hands and an extra set of eyes throughout their treatment.
Q: What risks or side effects should patients know about, and how are patients kept safe?
Evans: This study is a Phase 1 clinical trial, meaning researchers are continuing to evaluate the best dose and gather additional safety information. Although it's an early clinical trial, it's by no means the first time that this fluorescent compound has been used in human patients. In extensive earlier pilot studies, we didn’t observe any unexpected side effects or toxicities.
Importantly, the decisions that I make as a surgeon, or the decisions made by other surgeons who are part of this clinical trial, are not based on the study drug—they’re based on standard of care.
We keep a very close eye on patients throughout the study to make sure they're safe. Patients are monitored before, during and after surgery, undergo additional safety testing, and have access to research staff who can answer questions or address concerns at any time.
Q: What questions do patients commonly ask before joining the trial?
Evans: Typically I get three questions: The first is how exactly is this information going to help patients in the future? I respond that we're learning more about this drug, and hope we'll be able to offer this to patients more broadly in the future.
Another question that reasonably comes up is, "Does this impact how you do my surgery?" And the answer to that is no. We take additional pictures to look at the fluorescence from this drug, but everything we do at the time of surgery still boils down to standard of care. Patients can still be comfortable that they're going to have a safe, effective surgery even though they're participating in a clinical trial.
Lastly, patients ask, “How is this going to potentially impact me going forward? We think the impact will be minimal. We have good evidence of safety so far, with no adverse reactions or side effects. Participation does not alter the follow-up care patients receive. Surgeons follow standard treatment approaches, and patients remain eligible for radiation therapy, chemotherapy and future clinical trials if needed. Also, because the study takes place during surgery, there is no logistical burden of unexpected visits or disruptions to a patient's treatment plan.
Q: What excites you most about this trial and about caring for patients with brain tumors at Dartmouth Health?
Evans: I'll answer that first for our patients. Having grown up here, I know how hard it can be for patients in rural areas to access the care they need and clinical trials. What excites me most about this trial is the opportunity to expand access to cutting-edge clinical research for patients across our rural region without the burden of additional travel or extra hospital visits, while helping advance care for future patients.
I'm also excited about what this research could mean scientifically. We have impressive technology that lets us do amazing things in the operating room and perform brain tumor surgery safely. But I think we can do better. And we are. This trial has come from years of experience beforehand, when scientists that I work with had an idea to make a new compound, make a new drug, and we've actually been able to see it move from the lab at Dartmouth into the hands of surgeons and patients at Dartmouth Health who need it.
To me, this is one of the things that epitomizes what’s special about Dartmouth Health, Dartmouth Cancer Center and the Dartmouth community: the vision and innovation of people here and the spirit of collaboration, all in the name of improving care for our patients.
To learn more, visit clinicaltrials.gov study number NCT07063693.