Ruminations

Taking a Pill ... for Cancer

"I didn't notice I was losing vision at all, because I was young. I didn't know what a brain tumour was. I didn't know what cancer was then, so it was pretty hard for me to understand."
"There's always something to look forward to. When I'm going through something tough, I think about what's going to happen in the future. And once I finish this [treatment], it's done."
"So it's better for me to think about what's going to happen later on after I do that."
"What I try to do is stay positive. Be strong and just know that you can get through it ... just have a positive mindset with what you're going through, even though it's really tough."
"Think about what you can do in the future."
Julia Van Damme, 12, Pediatric brain cancer patient

Still from video

"In the past we used to treat kids with brain tumours just based on looking at the tumour, by how the cells looked [under a microscope] and by looking at the imaging."
"We did all umour types sort of the same."
"Then we realized that using these molecular tools, we can actually tailor treatment to some patients that's different than others."
"We can say for your tumour, it's going to be very, very low-grade, slow-growing, and we should refrain from any toxic therapy. And for the other ones, we need to be more aggressive."
"And the last part of that, which is amazing, is that some tumours will actually have pills that target the mutation. So instead of giving chemotherapy, radiation and aggressive surgery, you can just give the pill and the tumour will respond and the patient will get better."
Dr. Uri Tabori, neuro-oncologist, Hospital for Sick Children, Toronto

"One of the issues that we run into with pediatric brain tumours, in particular, is that although some commercial entities have developed tests for adult brain tumours, most of them don't do it for pediatrics because the numbers just aren't big enough to make it financially viable."
"And most of these tests we had to develop from the ground up at Sick Kids."
Dr. Cynthia Hawkins, neuro-pathologist, Hospital for Sick Children, Toronto

Julia van Damme, 12, was diagnosed with a low-grade glioma brain tumour after a routine eye exam when she was 8 years old. (Chris Donovan / THE CANADIAN PRESS)

For then-eight-year-old Julia it was horribly bad luck that she had a pediatric brain cancer. She was one among the roughly 25,000 to 30,000 children globally who will be diagnosed with this dread illness. On the other hand, if one were to have such a dread diagnosis, best that it be, as hers was, a low-grade glioma, lending itself to a new and impressively useful type of therapeutic action. That she has a supportive family also helps, enormously. She has a stay-at-home mother in a single-earner family.

Julia has two siblings, both younger than she is, but both, like their parents, fully involved in her well-being, supportive emotionally and in any other possible way that encourages Julia. She is also fortunate that she lives in a city whose hospital specializing in the treatment of children, staffed by health professionals at the top of their game, looking for new and improved methods of treatment to give hope and health back to their patients.

Dr. Hawkins, for example, is wholly involved in developing the type of molecular tests that assist doctors to diagnose and treat certain sub-types of childhood brain cancers. Those tests are useful in understanding glioma and medulloblastoma, a malignancy accounting for roughly 20 percent of all childhood brain tumours, fast-growing and potentially lethal. Her laboratory at the hospital receives requests from hospitals in Canada, the United States and worldwide for molecular analysis of tumour samples they forward.

Julia has always been an active child and at age eight fully engrossed in schoolwork, in participating in sport activities and generally having a good time doing what young children do. And then a routine eye examination discovered something unusual and unexpected, that she was almost blind in one eye. An MRI turned up the information that Julia had a golf-ball sized tumour in her brain and its pressure on her optic nerve was impacting on her left eye, destroying her vision.

The tumour biopsy revealed the presence of a low-grade glioma centered in her brain above the pituitary gland. Surgical removal was out of the question and the risk of deleterious long-term effects was too perilously high for that area of her brain to be radiated. Instead, she was exposed to standard chemotherapy over a year-and-a-half of weekly intravenous infusions. But that intervention was successful in shrinking her tumour.

It was discovered by analyzing the molecular makeup of Julia's cancer that a single genetic mutation called a BRAF V600E was responsible for her cancer. This genetic signature was known through research to respond well to a drug normally used in the treatment of adults with malignant melanoma, the potentially deadly form of skin cancer. Another part of Julia's therapy was then launched. She takes two pills each -- an oral medication called Dabrafenib -- once at night and once in the morning.

This regimen has succeeded in ensuring her tumour has not progressed. Her tumour shrank by about 15 percent and has stabilized at its reduced size. Previous to that eye examination, Julia hadn't even suspected she was experiencing difficulty with her vision. She had an A average at school, played soccer and hockey. And at this stage in her life, four years on, she regards her illness and the experiences she has had with full equanimity, trusting in the future and looking forward to a full and rewarding life.