Health Topics

Darren’s Treatment

Andrew Schorr:

All right. And you of course specialize in this. So you have your neurosurgeons who are trained in the brain surgery, and then there's radiation oncology specialized to the brain, and there's medical oncology, your neuro oncologists and quarterbacking or coordinating all this. So in Darren's case after the surgery he started some drug therapy, and he went through was it six weeks of radiation? Is that right, Darren?

Darren:

That's right. With Dr. Marymont at Northwestern, which was quite an experience. Not a good experience, but the best that they could have made it be for me.

Andrew Schorr:

Sure. Five days a week, right?

Darren:

Yep. Five days a week from about 7:45 in the morning until about 7:56 in the morning. And I couldn't wait for 7:57.

Andrew Schorr:

I'm sure. Okay. So, Dr. Raizer, you cut out everything you can, the radiation team does there part-you try to be very specific in radiation. Tell us about drug therapy, and the drug therapy that he had I know is a commonly used drug, Temodar, and later I know was added another drug that is just news to me, what we think of as an acne medicine, Accutane. So tell us about the drug therapy and where that comes in.

Dr. Raizer:

So I'm actually going to back up two steps a little bit.

Andrew Schorr:

Sure.

Dr. Raizer:

I think Darren's case kind of illustrates that a little bit of how the process works. So the first thing the surgeon does, and we always have to have surgery because we need tissue to make a diagnosis. They always take out everything they possibly can that they can do safely, but for one thing when we talk about a gross total resection that doesn't mean every single tumor cell is taken out. So we always know that there's some tumor cells left behind, which kind of makes it a bit different than something like colon cancer where they can sort of remove the tumor with a good margin on both sides. We've got limitations in the brain of how much we can take out before we handicap people, and we don't want to do that. So the surgeon takes out as much as he can safely but even when he takes out everything he sees we know that there's residual tumor left behind, which is really the need for the other therapies to follow.

Now, in Darren's case somebody would have to look at the picture of the MRI scan and the pathology, and we actually had some questions as to what the pathology actually was, and we got multiple readings on it. And Darren can correct me, but I think we might have had four opinions on it…

Darren:

Yes.

Dr. Raizer:

…At the time because it wasn't really clear. I think two of them actually sort of agreed, and that's sort of what we went with as what probably a diagnosis was. But it also reinforces the fact that if something doesn't make sense on a scan it's always good to get a second opinion on pathology especially from people who come from major, major academic centers, like from Memorial Sloan Kettering Cancer Center, M. D. Anderson, where they're just such big programs that they see hundreds to thousands of tumors a year. And so I trust my pathologists fully, but on occasion we really need to sort it out because that can influence how we treat the patients. And then typically when they have an anaplastic tumor we in most cases, especially if they're astrocytomas and oligodendrogliomas, which has a little bit of a split on how to treat if there's some chromosomal changes in the tumor, but typically follow surgery with radiation therapy.

Now, there's been kind of a shift in the treatment of these tumors where some people will use radiation followed by chemotherapy for oligodendrogliomas, and others will treat them with radiation and chemotherapy together. And we don't yet know what's the best approach, but there's studies under way to try to address those issues to see if we can sort that out. And then typically once radiation is over patients go on to maintenance therapy, and really depending on the grade of tumor I typically treat anywhere from 12 to 24 months if things are looking good.

And then in some patients when we try to be more aggressive we can add other agents onto the mix like Accutane, which you mentioned, which, as you said, is an acne medicine but we use it in far higher dosages. And it's actually been shown to be effective as a single agent, and it seems to have some additive benefit when you add it to other agents. And then in some cases when we reach a certain point of chemotherapy we often think about stopping it because if tumors appear to be cured or in remission some of the drugs like Temodar that we use, Temodar, have a low instance of getting secondary hematologic side effects later on down the line like leukemia or something called myelodysplastic syndrome. So I'm always a little bit reticent to treat somebody forever because if they're doing well I don't want to give them another problem to have to deal with. And then someone like Darren we sort of left on maintenance Accutane in the hopes that it will continue to give him some benefit over the years. It seems to be doing so.

Andrew Schorr:

Right. We have so much more to talk about. Darren is going to tell us about how well he is doing now. We're going to take a quick break, and when we come back we're going to hear how, and I hope you've noted, he was diagnosed in May of 2005 after having the problem for months, and we are now doing this in 2009, so things have worked out well for Darren. Much more to come on our live broadcast. We'll be right back with much more.

Andrew Schorr:

Welcome back to our live webcast. Andrew Schorr here. We're talking about brain tumors and we have some excellent guests associated with Northwestern. Now, earlier we introduced you to Darren Latimer, who is a businessman and investment banker, and he's actually calling in from one of the frequent flyer rooms at the Los Angeles International Airport before he boards a flight to come home to Chicago. But he was treated at Northwestern and received excellent care. He was diagnosed in May, really, of 2005 but having problems for months before that. The worst headache of his life and that was being repeated. Some vision problems, pressure on his eye, turned out to be a lemon sized tumor behind his right ear.

And then also joining us is the co director of the brain tumor institute at Northwestern. That's neuro oncologist Dr. Jeffrey Raizer. So I want to point out something to you because so often when you think of, and Darren mentioned it, someone is diagnosed with a brain tumor you think, well, necessarily put your affairs in order. That's it. You will not be around for a long time. Well, that does happen of course, but it doesn't always happen, and that's what we strive to with the experts who explain how they're really working to cure it or give you a long life. And I think it's important to say Darren is on a business trip and he's a banker and he need all his faculties and he's doing well. And after having that one child who was with him and his wife, Allison, at the time of diagnosis, that scary night, late night in the emergency room, they now have two other young girls. So obviously Darren is invested in a long, long life.

Darren, so you continue to take the Accutane, and you completed the other earlier chemotherapy and the weeks and weeks of radiation and the pretty aggressive surgery. How do you feel?

Darren:

Well, I'll be honest. Besides the baby getting up at four o'clock in the morning I feel great. I run. I bike. I exercise. I swim. I work hard. I play pretty hard. After this trip I'm on my way to Las Vegas as in a couple days for a college reunion. So I live my life because every morning I wake up I want to live my life. And I could sit there, I could pout for a while. I could just sit and look at the stars, but I'll tell you something, two weeks after my surgery I was walking back to work because I couldn't sit home and watch Oprah. I had to get back on with things. And I refused to believe the stats on the internet, whatever they say. Some are good. Some are bad. So I feel great.

Andrew Schorr:

Now, there's one other thing you did that we should point out, and that is you decided that you wanted to do all you could to help healthcare be the best it could be and research for people affected by brain tumors, and so you've been very active as a fundraiser for Northwestern's brain tumor institute. And I guess you're a believer that bringing the specialists together who just do this, the whole team, pathology, surgery, neuro oncology like Dr. Raizer, radiation oncology but specializing in brain tumor, and research, that that can hopefully help people do better.

Darren:

You know, you're right. Collaboration is so important, and I talk to a lot of people around the country who are at other hospitals who have had brain tumors and similar cases to mine, and I'm on boards here in L.A., I'm on a board in New York, but what I've found and am finding at Northwestern is the collaboration of neuro oncology and radiation and surgery and the nurses and the social workers, everyone is on the same page, and they believe in the person and not just a number, and that's extremely important. So you're right. In December 2005 while I was still kind of I'll say geeked up on medicine and Temodar on a blizzard night in December we held my first fundraiser, and it was a real success. And it really parlayed towards other fundraisers and the official NBTI because it's the right place to be at the right place in my life with the hand I've been dealt.