The NOB has made substantial progress towards building an infrastructure necessary for fulfilling its mission of developing new and improved therapies for children and adults with brain and spinal cord tumors. Below are partial lists of accomplishments in the building of the Brain Tumor Clinical and Clinical Research Program: Established an NIH-wide multidisciplinary Brain Tumor Clinic with active participation from three different NCI Branches (ROB, MOCRU, CCRLP), five different NIH Institutions (NCI, NINDS, NEI, NHLBI, NIMH), and five different Clinical Center Programs (Neuroradiology, Psychiatry, Pain and Palliation, Rehabilitation Medicine, Social Work). Expertise represented in the clinic includes Medical Oncology, Radiation Oncology, Neurosurgery, Neurology, Ophthalmology, Cardiology, Psychiatry, Endocrinology, Social Work, and Rehabilitation Medicine;Assembled a primary neuro-oncology clinical care/research team, which now consists of 4 neuro-oncologists, 6 NOB-trained neuro-oncology nurse practitioners, 3 research nurses, 2 neuro-oncology fellows, 2 patient coordinators, 2 clinical trials specialists and 5 data managers;Established a robust neuro-oncology consultation service, in which local/regional patients are seen and followed at the NIH (all patients are accrued to a CNS tumor natural history protocol;distant patients may just have radiology/medical records reviewed;Serving as Chair of the Search Committee, Howard Fine helped recruit two new tenure track clinician/scientist brain tumor neurosurgeons to NINDS/NCI leading to a total of 5 clinically active brain tumor neurosurgeons in the Surgical Neurology Branch, NINDS;Activated more than 30 IRB approved clinical trials with an additional 4 expected to be approved in the coming months, for a total of 30 protocols compared to just 1 protocol existing for primary brain tumors at the NIH when the NOB was formed in 2000 (a prior radiation protocol that had accrued 500 new primary brain tumor patients (almost all gliomas) and between 2000-3000 follow-up patients over the last 12 months, up from <10 patients with malignant brain tumor seen at NIH in the year before the NOB was formed (1999). Additionally, the NOB reviews 2-6 new mail-in patient consults per week. Provides almost all neuro-oncology services for Walter Reed Medical Center, the Portsmouth Naval Hospital, and the Naval Medical Center in Bethesda;Established close collaborative clinical programs with Johns Hopkins Medical Center, George Washington Medical Center, Fairfax Inova and Washington Hospital Center and a wide array of private neurosurgical, radiation, and oncology practice groups locally and nationally;Created one of only a few organized neuro-oncology fellowship training programs in the United Statesa three-institution joint research training program between the NIH, Johns Hopkins Medical Center, and Childrens National Medical Center in Washington, D.C.;Identified five compounds through the preclinical screening program that have since been brought forward to clinical trials at the NIH (CC8490, LY317615, Velcade + Tamoxifen, CC5013, Talampanel, MLN518, Sunitinib). We have also initiated a truly unique study that could only be accomplished at the NIH and the Clinical Center for all practical purposes. In an effort to try and understand the intra-tumor heterogeneity found within the brain of a patient with malignant gliomas at a functional and tumor stem cell levels it is necessary to obtain viable tumor and normal tissue for all regions of the brain. Obviously such a sampling can not be done on alive patient but unfortunately, we have found that autopsy specimens that are as fresh as 12 hours from death are too old to grow viable tissue. Thus, we initiated a unique trial where patients and families who wish to donate their brains to brain tumor research are admitted to the Clinical Center shortly prior to death for hospice/end of life care. Immediately upon cardiac arrest the patients body is quickly brought down to the surgical suite and under sterile surgical conditions the brain is removed from the cranial vault by one of our neurosurgeons and then quickly dissected with all of the appropriate tissue samples immediate frozen and/or put into culture for tumor cell growth. This study will give us unprecedented opportunity to construct a tumor cell-based genomic microanatomical map of a human brain harboring a GBM. This trial typifies the close and intertwined functioning of the clinical and basic science research effort of the NOB. Activated more than 9 clinical trials as a direct result of translational work performed within the Neuro-Oncology Laboratory.
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