The Preston Robert Tisch Brain Tumor Center conducts groundbreaking research and offers innovative treatment for brain tumors. It is dedicated to caring for pediatric and adult patients and their families, improving their quality of life, and ultimately finding a cure for brain tumors.
Visit DukeHealth.org for more information about glioblastoma and other primary brain tumors.
The Preston Robert Tisch Brain Tumor Center is one of the first brain tumor research and clinical programs in the United States. The center has more than 250 full-time employees devoted exclusively to neuro-oncology. It encompasses basic, translational and clinical research, adult and pediatric clinical care services, and quality of life/supportive care programs.
Approximately 900 new adult brain tumor patients and 80 new pediatric brain tumor patients come to the Center each year from around the world. We care for all types of brain tumors, including glioblastomas, meningiomas, and benign brain tumors. We develop a personalized approach for each patient.
The pediatric neuro-oncology program has specific expertise in immunotherapy. We are part of the Pacific Pediatric Neurology Consortium (PNOC) and the COllaborative NEtwork for Neuro-oncology Clinical Trials (CONNECT). Together, we seek to develop new therapies and improve outcomes for children and young adults with brain tumors.
The Preston Robert Tisch Brain Tumor Center's research program is dedicated to finding better outcomes for brain tumors. Novel immunotherapies, including cancer immunotherapy with viruses, immunotoxins, vaccines, and others, were co-developed at Duke to generate tumor immune surveillance fighting cancer in the brain. Through our clinical trials, you may be eligible for studies that use novel therapies to treat brain tumors.
We continue to explore ways to selectively target tumors, tame fast-growing and drug-resistant tumors, and design new therapies to destroy cancer. Our researchers are also studying ways to manipulate the genes and proteins that fuel tumor growth.
Our researchers receive approximately $14.4 million in grant and contract support. Three of the Center’s faculty members (Darrell Bigner, Henry Friedman, and Roger McLendon) are among the top 20 most cited authors on “glioblastoma” in the world.
Training future neuro-oncology providers and scientists are part of the Center’s mission. The robust training program focuses on students at the high school, undergraduate, pre-doctoral, and post-doctoral levels. Most investigators train one or more students in their laboratories each year. We also offer fellowships in adult neuro-oncology and pediatric neuro-oncology.
Duke Cancer Institute Executive Director Michael B. Kastan, MD, PhD, presents medical student Priya Alagesan, BS, with the Robert and Barbara Bell Award For Basic Science Cancer Research at the 2022 DCI Scientific Retreat.
For the first time since 2019, the Duke Cancer Institute Scientific Retreat was held in person with a full program followed by a poster session and mingling. Held on December 2, 2022, the retreat attracted around 90 faculty, staff, and trainees (students, residents, fellows, postdocs, etc.).There was also a virtual option, which an additional 184 individuals took advantage of — whether out of convenience or caution during a season of rising Covid-19, Flu, and RSV infections.“Good afternoon, everybody. It's a pleasure to welcome you to the ninth annual Duke Cancer Institute Scientific Retreat. It's wonderful to be able to be in person again. I know this is a hybrid meeting, so we don't have everyone here. Maybe 15% of the audience is in person — but this is better than zero," said Executive Director of Duke Cancer Institute and host of the event Michael B. Kastan, MD, PhD. "We have a wonderful afternoon planned with selections of the top abstracts from each of the Cancer Center programs, a faculty presentation by Dr. Epplein that we're very much looking forward to, and then our keynote speaker for the Colvin lecture, Peggy Goodell from Baylor will be wrapping up the afternoon prior to the poster session.”Commemorations of DCI's 50th Anniversary as a National Cancer Institute-designated Comprehensive Cancer Center were in evidence in nearly every presenter’s PowerPoint — emphasizing their pride in the tremendous impact of current and former DCI investigators and clinicians on cancer research and patient care in the U.S. and around the world.Seven DCI Trainee Members — one from each of DCI's seven basic, clinical, and translational National Cancer Institute-Designated Research Programs — were selected by program leaders and the scientific review committee to present their research at the retreat. (Previous to the retreat all trainees were invited to submit, for oral-presentation consideration, an abstract on their research project).Six of the trainees received a $1,000 award from the DCI and the trainee with the most innovative basic-science research project, as is customary at the annual retreat, received the Robert and Barbara Bell Basic Science Cancer Research Award in the amount of $5,000.Each trainee was introduced by either their mentor or a research-program faculty leader and took questions after their presentation. Between affirmations, friendly critiques, probing questions, and ideas for further exploration, there was no debating that the learning was infectious.In three presentations, the learnings were literally “infectious.”Meira Epplein, PhD, MS, MA—co-leader with Katherine Garman, MD,of the National Cancer Institute-designated DCI Cancer Risk, Detection and Interception Research Program (CRDI) — plus two of seven top trainees addressed, each from different angles, the bacterial and viral associations with and molecular drivers of gastric cancer, and potential strategies for both treating it and stopping its development before it starts.Other topics of the afternoon included:a patient experience study on barriers and facilitators to care in Black patients with newly diagnosed leukemia (specifically AML);a pathology/immunochemistry computational mapping study — deep learning — to characterize the features of the immune micro-environment landscape;novel approaches for: targeting fusion-driven rhabdomyosarcomas; targeting glioblastoma stem cells, otherwise known as brain-tumor initiating cells; and making breast cancer more receptive to treatment with immunotherapies by using targeted therapy/vaccinationand a review, by the keynote speaker, of the mechanisms that regulate hematopoietic stem cells and how they go awry in blood cancersGastric Cancer in Focus
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A table of posters made by kids and adults for World Cancer Day, Feb. 4, 2022.
Duke Cancer Institute is joining a new initiative with the Global Pediatric Brain Tumor Network, Bayer, the National Brain Tumor Society, other institutions, and Africa partners to "create an equitable ecosystem of care for pediatric brain cancer patients" across the continent of Africa. The announcement was part of a communique issued by The White House on December 14 during the U.S. Africa Leaders Summit.Using technology from the National Institutes of Health — a common digital platform — the group will connect African hospitals with U.S. hospitals and biomedical innovators in order to improve patient experience and outcomes. Specifically, the initiative will "help match pediatric patients to neuro-oncologists, clinical trials, potential treatments, and organizations that may be able to help close geographic, financial, and cultural barriers."The new initiative also "aims to contribute to the acceleration of new drug development by participating in multinational pediatric clinical trials and thereby enable earlier access to newer and more innovative therapies for patients in the United States, Africa, and other partner countries."The pediatric brain cancer initiative is part of a broader White House Cancer Moonshot initiative to dramatically improve cancer outcomes across Africa.Duke Cancer Institute member H. Kim Lyerly, MD, — the George Barth Geller Distinguished Professor of Immunology, professor of Surgery, professor of Pathology, and executive director of the Center for Applied Therapeutics, Duke University School of Medicine — and pediatric neuro-oncologist Daniel Landi, MD, are co-leaders on the project.This was one of several new Moonshot-related initiatives announced during the U.S. Africa Leaders Summit.First launched in 2016 by the Obama administration and led by then-Vice President Joe Biden to “accelerate scientific discovery in cancer, foster greater collaboration, and improve the sharing of cancer data,” the Cancer Moonshot was reignited in February 2022 by President Joe Biden and First Lady Jill Biden, Ed.D. The new goals are to “reduce the cancer death rate by half within 25 years and to improve the lives of people with cancer and cancer survivors.” (The Cancer Moonshot was not active during the Trump administration.)
When Joseph O. Moore, MD, came to Duke as a fellow in 1975, he and his mentors treated chronic myeloid leukemia (CML) with a chemotherapy regimen that was like a “wet blanket.” It suppressed the cancer for a few years. “But it didn’t change the trajectory of the disease,” Moore said. Patients developed acute leukemia, which was almost always fatal.
By the early 1990s, younger patients could achieve a cure with a bone marrow transplant, though complications were common. By 1999, Moore was the Duke investigator for a national study of a targeted drug, imatinib, which stops leukemia cells from growing by shutting down a key protein.
When imatinib was approved by the Food and Drug Administration (FDA) in 2001, it transformed CML into a disease easily treated by taking a pill.
When Moore retired from clinical practice in 2019, he was involved in a study following people with CML who had been taking imatinib long term, which showed they could safely stop therapy.
The CML example provides a snapshot of just how far cancer treatment has come in the last 50 years. For many patients, “There’s an expectation of success and people living normal lives,” said Moore, professor emeritus of medicine.
Much of that progress can be traced to research funded by the “war on cancer,” which launched in 1971 when congress passed the National Cancer Act. The act gave the National Cancer Institute (NCI) the authority and funds to create a national cancer program. The backbone is a network of comprehensive cancer centers that provide patient care and conduct rigorous research to find new and better ways to prevent, diagnose, and treat cancer.
The Duke Cancer Institute 8th Annual Scientific Retreat, held on December 3, 2021, attracted a broad array of faculty, trainees (students, residents, fellows, postdocs, etc.) and staff.For a second year, the retreat was entirely virtual and there were no poster presentations owing to the ongoing Covid-19 pandemic.“Hopefully, this will be the last time that we have to do it this way,” said executive director of DCI, Michael Kastan, MD, PhD, welcoming participants over Zoom.That it was virtual didn't stop a series of lively discussions from moving full-steam ahead on a full Friday afternoon on topics such as DCI cancer health equity and engagement strategies, viral lymphomas, bone loss as a CLL co-morbidity, ways around immune system evasion, cardio-protective cancer therapy, new approaches for treating head and neck squamous cell carcinoma, clues as to how cystic lesions progress to pancreatic cancer, unlocking immune dysfunction in glioblastoma, cholesterol-control drugs and cancer, and the PARP revolution.“We have a very full agenda today with great science from Duke trainees and faculty and are also celebrating several different anniversaries. First, it's my 10th anniversary as director of the Duke Cancer Institute and I have to say it's been a real privilege of my life to be in this role and to be able to work with such extraordinary people here. And I couldn't be more proud of everything that all the staff and all the faculty have done during the time that I've been here," said Kastan. "We're also celebrating the 50th anniversary of the National Cancer Act, which was signed in 1971, and put us down the path to NCI-designated cancer centers. The Duke Comprehensive Cancer Center (now DCI) was one of the original eight."Kastan also noted that DCI's own 50th was on the horizon."This year we begin celebrating our 50th anniversary. We've made a tremendous impact on cancer research and patient care in the U.S. and around the world.”
Duke Cancer Institute Blog
Terence Wong, MD, PhD, right, meets with a patient before his PSMA PET/CT scan. Duke is a leader in this type of imaging, which is used in combination with a radiotracer to identify if there's a druggable molecular target. (A version of this photo originally appeared in a Duke Health article in February 2022: "PSMA PET/CT Scan Improves Prostate Cancer Detection and Treatment")
The Society of Nuclear Medicine & Molecular Imaging has designated the Division of Nuclear Medicine and Radiotheranostics at Duke Health as a Comprehensive Radiopharmaceutical Therapy Center of Excellence. A national leader in radiopharmaceutical therapy (RPT), the Division is currently one of only 14 Centers in the U.S. to receive this recognition.
In addition to having technical expertise and appropriate treatment facilities, Centers must meet rigorous training, regulatory, and performance criteria, and are required to provide education and scientific contributions to this growing field. They must administer more than 40 RPT treatments per year in at least two of these disease-specific therapy areas — thyroid, neuro-endocrine tumor, and prostate.
“Duke has a long history of research and clinical experience with radiopharmaceutical therapies; dating back to the late 1990s when radio-labeled antibodies were developed at Duke by Darell Bigner (Preston Robert Tisch Brain Tumor Center) and Michael R. Zalutsky (Department of Radiology) to treat malignant brain tumors,” notes Duke Cancer Institute nuclear radiologist Terence Z. Wong, MD, PhD, FACR, chief of the Division of Nuclear Medicine and Radiotheranostics, a clinical division of Duke Radiology. “The designation as a Comprehensive Radiopharmaceutical Therapy Center of Excellence reflects the culmination of many years of teamwork.”
The Division has utilized radioiodine to treat thyroid diseases (including cancer) for decades and has been one of the leaders in the field using 131I-MIBG (a drug containing a form of radioactive iodine, also called AzedraTM and iobenguane I 131) to treat pheochromocytomas (cancer of the adrenal gland) and carcinoid tumors (a type of neuroendocrine tumor). Duke has been a national leader in treating patients with neuroendocrine tumors using LutatheraTM (177Lu-DOTATATE) since 2018, when it was approved by the FDA. More recently, Duke was one of the first cancer centers to offer PluvictoTM (177Lu-PSMA) to treat metastatic prostate cancer following its FDA approval in March 2022, and is currently the leading site in the U.S. for treating prostate cancer patients with this new radiopharmaceutical therapy.
“Large clinical trials have shown that the radiotheranostic approach can provide clinical benefit for patients with neuroendocrine tumors and prostate cancer, even in patients with advanced disease that is refractory (unresponsive) to other treatments,” explains Wong, who has a secondary faculty appointment as a professor in the Duke Department of Medicine, Division of Medical Oncology. “As a National Cancer Institute-Designated Comprehensive Cancer Center, Duke Cancer Institute is well-equipped to provide these novel treatments.”
“Radiotheranostics” is the concept of using a molecular probe directed at cancer cells to both identify and treat that cancer. Azedra, Lutathera, and Pluvicto are all delivered this way.
First the molecular probe is labeled with a small amount of radioactivity called a radiotracer, which allows the potential treatment sites to be identified by imaging. Duke has been a leader in this type of imaging; 68Ga-DOTATATE PET/CT for neuroendocrine tumors and PSMA PET/CT in prostate cancer.
If the imaging shows that the tumor cells have a druggable molecular target, the area can then be treated with the targeted radiopharmaceutical therapy using the same or similar molecular probe — delivering a high radiation dose to the specific tumor sites while sparing adjacent normal tissue.
Radiotheranostics has progressed rapidly over the last decade and is moving quickly into the mainstream of cancer therapeutics. It was this “recognition of the present and future potential of radiolabeled targeted therapy,” notes Wong, that led to the Division of Nuclear Medicine being renamed the Division of Nuclear Medicine and Radiotheranostics in 2020.