Researchers at UNC-Chapel Hill are among those working on new ways to help treat brain cancer. They published a paper this month that shows promise for a method of drug testing that could be customized for each patient.
One of these researchers is Andrew Satterlee. In 2007, as a college sophomore, Satterlee was diagnosed with a rare form of brain cancer.
His treatment was successful, and he’s been cancer free for 16 years. But he remembers a time early in his diagnosis when his doctors didn’t agree on how to proceed.
WUNC's Will Michaels spoke with Satterlee about his path from being a cancer survivor to cancer researcher, starting with Satterlee's own diagnosis and treatment. The following is a transcript of that report. It has been lightly edited for clarity.
ANDREW SATTERLEE: This is a terrifying story, but it starts off, got some headaches. It got worse, went away for a while with Tylenol, and then didn't anymore. And I didn't know what was going on. I went to the doctor and thought it was a sinus infection. And then I went back, and I still remember, he had this interesting way of saying things a little bit eccentric, he would say, "You're not getting better, you're getting worse." You know, looking at me, like, "This doesn't make any sense. I've given you my two antibiotics, you're not getting better, you're getting worse."
I couldn't sleep one night. I was starting to get this double vision, which still persists. I still have trouble getting my eyes to work together. And I left my house late at night and went and got some Tylenol PM from the Walmart … try to go to sleep, wake up the next morning and get in the shower and blackout in the shower, pass out, throw up in the toilet. And that's kind of when I knew that something was up.
WILL MICHAELS: Andrew’s brain scan showed a tumor the size of a golf ball. He quickly had a procedure to drain the fluid that was building up in his head.
Then, Andrew and his family decided to see Dr. Mitch Berger at the University of California at San Francisco. Andrew calls him the godfather of brain surgeons. It was Dr. Berger who successfully removed Andrew’s tumor.
SATTERLEE: A beautiful tumor resection. I still have pictures of the tumor on my computer ... then got the news the next couple of days that "Alright, your tumor is malignant. With chemo and radiation, you got a 70% chance you're going to be okay."
Like, okay, that's pretty good. But like, it's not great, right? That's where kind of all of this ambiguity about what treatment to give came into play. Even the experts didn't agree about what to do. The standard of care was changing. I didn't want to get full brain and spine radiation. But the heavy chemo was heavy. That's what I chose: heavy chemo, light radiation.
MICHAELS: But there are dozens of chemotherapy drugs.
SATTERLEE: And it kind of fell to me and my family, and my dad becoming this de facto researcher to try to figure out like what doctors know what drugs to give my son. And then for me, am I comfortable with the drugs that are being given to me? And even then, I thought, "There must be a better way than this." But I never thought that here I am 15, 16 years later building the tool I could have used.
MICHAELS: It’s called an organotypic brain slice culture-based platform. Researchers remove a rat’s brain, cut it in slices, and keep those slices alive artificially. Then, they take tumor cells that have been removed from someone who has brain cancer, and grow them on the brain slices. And finally, they bombard the tumor with different chemotherapy drugs to see which ones work best.
SATTERLEE: So for me, this is how it plays out, is that you're in these conversations with the doctor and you're removing ambiguity, you're removing subjectivity.
You've got some kind of standardization in the process where instead of saying, "This is the most potent drug. This drug will kill the whole tumor," what we do is say, "Well, that's fine, but can you do it without killing this brain slice that's just the healthy tissue you want to keep intact?" Instead of saying, "You have a non-germinomatous germ cell tumor, so we should do this treatment," we say, "You have a tumor that's sensitive to drug X, drug y, and drug Z, and then we're going to give you this combo of drugs, because we actually killed your tumor with them on the brain slice."
There are still things you need to know about the tumor in the body to help guide treatment, but this functional precision medicine work, I think, has the potential to turn this field on its head."
MICHAELS: Satterlee says there’s still a long way to go to get brain slice testing into a clinical setting. This kind of work takes an incredible amount of coordination to move freshly retrieved cancer tissue to researchers like Satterlee, not to mention a lot of time, money, and just the right timing.
SATTERLEE: Tumors take a long time to come out of a person’s brain. The surgeries are long. My surgery was an eight-hour surgery, so you imagine some of these tumors are going to come out really late and are going to be tough to catch in an environment where not everybody is working until midnight. We don’t get all the tumors we identify and that’s okay. We talk through this and say, "How can we be more efficient? How can we increase the success rate of getting these tumors to our lab?"
I do think we see successes every day. Every piece of new data that we get, I feel this excitement, right? Like we're one step closer out of 5000 steps. But we've got to make an impact in people's lives, right?
And here's me being disruptive: academia is set up to publish your paper to get your next grant to publish your next paper to get your next grant … Because yes, this paper is a success. It's a huge deal. But it's got to mean something to patients. It's got to get past this standard slog of academia, the hamster wheel.
If there's someone else that comes in with a tumor like mine, we want to be able to give him the right drug, a better way to give him the drugs that are going to help him the most.
