I’m Fueling Innovation:
Dr. Edjah Nduom

Getting a new treatment for cancer, especially complex and aggressive cancers like malignant brain tumors, is extremely challenging. Historical estimates are that less than 10% of experimental medicines for cancer that enter the clinical trial process will ultimately succeed in gaining FDA approval. It can take more than a dozen years and millions of dollars, across multiple clinical trials, involving hundreds of patients, before researchers can determine if a potential new medicine is worthy of FDA approval.

Therefore, any approach to accelerate drug development, including determining earlier in the process if an experimental therapy is worthy of continued investment of resources, could help prioritize the most promising new drug — those with the highest likelihood of success — while more quickly moving on from those less likely to be effective.

Enter Dr. Edjah Nduom, NBTS Board of Directors member and neurosurgical oncologist in the Surgical Neurology Branch (SNB) of the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH).

“I have always been interested in how things work,” Dr. Nduom recently told the NIH’s website. “I was the kid who was thrilled to get a science kit when I was growing up, because of all of the fun experiments that you could run. From the time I was little, I knew I wanted to do something challenging as a career, something that presented a new problem to solve on a daily basis.”

Dr. Nduom, a rising star in the neuro-oncology field, joined the NIH in 2015. In addition to his clinical role in the Surgical Neurology Branch, Dr. Nduom studies the use of immunotherapy for the treatment of brain tumors. In the process, he’s pioneering a new technique that would simultaneously leverage his neurosurgical skills, his interest in harnessing the immune system to destroy cancer cells, and potentially solve many of the challenges related to more rapidly determining the viability of an experimental treatment.

“During residency, while at a neurosurgery conference, I heard Russell Lonser, MD, who was
then the Chief of the Surgical Neurology Branch at NINDS, explain how neurosurgeons at the NIH were using catheters implanted directly into the brain to bypass the blood-brain barrier,” said Dr. Nduom. “As a budding neurosurgeon, I was hooked; I knew that surgery, while a critical part of treatment, would never be enough on its own to cure malignant tumors. This technique provided another way for surgeons to directly affect the treatment of brain tumors and complement the work of oncologists and radiologists.”

Dr. Nduom is now the principal investigator of an early-stage clinical trial at the NIH that will monitor the effectiveness of a combination of two immunotherapy drugs in real-time through the use of “microdialysis catheters,” thin tubes places in the brain temporarily to monitor the ability of these treatments to kick the immune system into high-gear against the tumor cells.

Eligible patients* who enroll to participate** in the study will be hospitalized for two weeks and undergo two surgical procedures. The first will take a tissue sample from the tumor and insert two microdialysis catheters to collect brain fluid and molecules. Two days after this surgery, participants will receive a dose of the first immunotherapy drug known as nivolumab. One week later the second surgery will occur. During this second surgery, as much of the tumor of possible will be removed, as well as the catheters. Following the two surgeries, patients will be discharged from the hospital, returning to undergo treatment with the combination immunotherapies every two weeks, while being monitored on a regular basis for recurrence of the tumor or any side effects.

While the catheters are in place, fluid and molecules will be collected every six hours.

Ultimately, Dr. Nduom and his team hope this innovative approach to treatment and clinical research — inserting catheters and providing the first doses of the drug even before surgery to resect the tumor, the typical first step in GBM treatment — will allow them to analyze, in near real-time, if changes are occurring in and around the tumor are providing the right signals that an effective immune attack against the tumor is underway (in addition to standard evaluations of safety). With this information, Dr. Nduom and his team will gain early insight into the potential effects of these treatments, and if this is a treatment approach worth continuing to pursue, or if they should quickly pivot to another.

If this new model of conducting an early phase clinical trial is effective, it could provide a blueprint for the field to use in many early-phase clinical trial efforts going forward, not to mention future advances in the treatment of recurrent malignant glioma patients.

Dr. Edjah Nduom is FUELING INNOVATION in the way the brain tumor field evaluates potential new treatments.

“To run a lab on top of being a practicing physician can be a challenge, but it comes with advantages both scientific and personal. Being the one to see the patient and surgically resect the tissue that will be used in my experiments means I have a much more complete understanding of how our findings in the lab relate to the bigger picture of a patient’s overall care.”

*Eligible patients:

  • Patients with recurrent glioblastoma that can be safely removed through surgery
  • 18 year of age or older
  • Have an intact immune system
  • Are willing to consent to the clinical trial treatment protocol
  • Are not pregnant, breastfeeding, or planning to become pregnant
  • Have no metal in their body
  • Have no bleeding disorders
  • Have no history of organ or tissue transplants
  • Are not undergoing treatment with another therapeutic agent

**All research-related care and experimental treatment are provided at no cost to the patients, and travel assistance may be provided within the U.S.

Learn more about this study.

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