Doctor brings breakthrough brain cancer treatment to Seattle

SEATTLE - Mary Steinbacher should not be alive today.

In May 2011, the 57-year-old Napa, Calif. photographer was shooting an event just before her husband Jeffrey Kozody left town for business. She does not remember the next eight days, but Kozody certainly does. During the first few days of his trip he tried to phone Steinbacher, but she never answered. Worried about his wife, Kozody came home early to find her lying in bed unconscious. Doctors believed she had been there for days.

At her local hospital, an MRI image confirmed that Steinbacher had a brain tumor extending into both frontal lobes. Doctors diagnosed her with advanced glioblastoma brain cancer and told Kozody his wife had 30 to 60 days left to live.

The first thing Steinbacher remembers after her episode was meeting Dr. Charles Cobbs, her surgeon and oncologist at California Pacific Medical Center in San Francisco.

"He said to me 'You're going to be okay,'" Steinbacher said. "And I knew I was."

Glioblastoma is the most deadly form of brain cancer, but Cobbs has spent years experimenting with a new treatment that could double survival rates. Still, given the limited research, potential side effects and high costs, his approach has not been embraced by the entire medical community. But Cobbs is hoping his new role as director of the Ivy Center for Advanced Brain Tumor Treatment in Seattle will allow him to lead further research into this exciting new approach to saving brain cancer patients.

Starting with a hunch

In 2000, while working as a professor of neurosurgery at the University of Alabama School of Medicine, Cobbs proposed an idea: What if brain cancers were caused by a virus?

Most of his colleagues thought the idea was ridiculous. If a virus was at the root of brain cancers, researchers would have discovered it already, they told him.

But, Cobbs wouldn't give up on the hypothesis. He focused his research on cytomegalovirus, a common virus that infects 50 to 80 percent of adults by age 40. The virus typically has no significant effects, but it can cause brain infections in newborns and patients with a compromise immune system.

Cobbs' hunch was verified in 2002 when he started testing cancerous tumor samples from patients and found every one tested positive for cytomegalovirus.

"It was jaw dropping at the time," he said. "These were the dark years. No one believed a virus could cause brain cancer."

Many, in fact, did not believe Cobbs claims until years later after his findings were confirmed by researchers at Duke University, MD Anderson Cancer Center and UCLA.

A treatment plan

Working under the assumption that brain tumors were somehow associated with cytomegalovirus, Cobbs considered whether the antiviral drug valganciclovir (Valcyte) - typically used to treat the virus in AIDS patients - could help brain cancer patients survive.

But Cobbs said very few believed treating the virus would benefit glioblastoma patients, with the exception of Dr. Cecilia Soderberg-Naucler at the Karolinska Institute in Stockholm. The two began collaborating in 2004, and in 2006 Soderberg-Naucler started a clinical trial treating glioblastoma patients with Valcyte in addition to a standard protocol of surgery, chemotherapy and radiation. For years researchers followed 25 patients taking Valcyte continuously.

While the median survival rate for glioblastoma is typically just 15 months and only 15 to 20 percent of patients live for two years, 90 percent of Soderberg-Naucler's patients on Valcyte lived for at least two years. Even more exciting for Cobbs and Soderberg-Naucler, the median survival rate of these patients was 56 months, or just over four and a half years.

Some of Soderberg-Naucler's patients taking the drug are still alive today. These findings were published this month in a letter to the New England Journal of Medicine this month.

"If these results are able to be repeated it would be the biggest breakthrough ever by far for brain cancer treatment," Cobbs said. "Successes in the past decade have only increased median survival rates by a couple months. We're talking about doubling survival rates."

Cobbs has seen improved outcomes in his own patients treated with Valcyte, including Steinbacher, who is still alive more than two years after doctors first handed her a death sentence.

"I feel so blessed," Steinbacher said. "I know I am alive today because of Dr. Cobbs."

Potential concerns

Despite the dramatic shift in survival rates, Cobbs said many are still hesitant to treat glioblastoma with Valcyte because its success has not been verified by a large, randomized clinical trial.

Additionally, Valcyte can have adverse side effects including diarrhea, vomiting and upset stomach as well as kidney or liver function damage. Cobbs said hardly any of his or Soderberg-Naucler's patients have experienced any serious side effects.

Valcyte is also expensive, costing a couple thousand dollars each month. Because it is not approved by the FDA as a treatment for cancer, insurance companies may not cover the cost.

Carrying out a legacy

Despite these concerns, Cobbs hopes the Ivy Center will lead further research of Valcyte in a phase-3, randomized trial that could involve brain cancer centers around the world. Already researchers in his lab have seen tumor samples shut down after being treated for the virus.

"I'm planning on the Ivy Center to take the lead in that next step," Cobbs said. "I would love Seattle to be the place to make this definitive discovery."

Much of Cobbs' research on Valcyte was conducted in San Francisco. His move to Seattle is largely credited to his friend and predecessor Dr. Greg Foltz, director of the Ivy Center until he died from pancreatic cancer in June. Foltz asked Cobbs to visit the Ivy Center a year before he died and hand-picked his friend to lead the Ivy Center after his death.

"It's bittersweet that I'm here now," Cobbs said. "His philosophy was to break down barriers and any blockade to curing cancer. I want to focus on doubling survival rates for this disease in the next few years, and we have evidence that says that is in reach."

Research at the Ivy Center is funded in part by the Seattle Brain Cancer Walk, which is held on Sept. 21 this year.