Part of the reason cancers are able to grow is because they are able to successfully hide from the immune system.
By reactivating the immune cells, a new class of drugs termed immunotherapies, have been shown to increase survival for certain cancers such as melanoma. The common theme in these cancers is that they harbour many mutations in their DNA, which allow the immune system to recognise them as foreign. Immunotherapy is not as effective for glioblastoma (GBM), partly due to the low number of mutations and an inability of the body to therefore mount an effective immune response to the tumour.
In Oxford we are using cutting edge technology to study the immune response in GBM at great depth. We are able to identify and characterise individual white blood cells inside the tumour and patients’ blood to see if they are able to detect the tumour and if there are any reasons why they are not acting as efficiently as possible. In addition, we are also using this information to explore new ways of increasing the immune response in GBM. As part of this, we are testing previously untried combinations of drugs as well as setting up a new method of testing many new compounds that have never been used before to see if we can make these tumours more detectable by the immune system.
We hope that this information will provide enough data to advance into a clinical trials with existing drugs in new combinations to directly help patients with GBM. In addition, we hope to identify new drugs that are in development to bring to clinical use.
Personalising tumour treatment using advanced MRI
Our research uses advanced MRI techniques to understand, and minimise, the impact of brain tumour treatment on people’s quality of life. The main aims of our research are to:
One
Inform the risks and benefits of surgery to reach shared treatment decisions,
Two
Gain a better understanding of how the brain recovers.
Three
Tailor treatment plans, knowing how each tumour uniquely affects a person’s brain.
The treatments that we currently have available for brain tumours can affect people very differently. Some tumours do not cause any symptoms and can be removed safely. In other people, treatment may damage speech or movement and reduce their quality of life. Knowing – based on clinical scans – the exact location of a tumour gives us a good indication of the risks of treatment. However, to minimise these risks and reduce disability, it is also important to understand how a tumour affects the healthy brain around it. For this, we need a different approach to measure the inner workings of the brain.
Advanced types of MRI brain scanning offer a window into each person’s unique brain. Using two safe and painless techniques called functional MRI and tractography, we can now follow how a brain tumour and its treatment affects people’s performance and recovery.
Functional MRI: Using functional MRI, We now know that some people’s brain adapts to a tumour. For example, the areas normally important for speech may move to another part of the brain distant from the tumour. We do not know why this happens in some people but not in others. Understand this process is an important area for research; if we knew what causes brain reorganisation, we might be able to help the brain adapt and recover more quickly after – or even before – treatment. Using functional MRI scans before and after surgery, we are researching which clinical characteristics most influence brain adaptation, especially for language and memory.
Tractography: A second reason why some people have symptoms and others do not is related to the essential wiring of the brain. Some tumours damage the nerve pathways that carry information through the brain. Other tumours simply push this wiring aside. The only way to tell the difference is using a MRI technique called diffusion tractography. Tractography gives us a map of where these nerve connections are in relation to a tumour. This information makes it possible for the surgeon to plan how much tumour could be removed, and to navigate the safest route to reach it. Additionally, tractography information may help to personalise radiotherapy treatments to ensure a tumour is given the right dose of radiotherapy while essential healthy brain tissue is avoided. We are researching if surgeries that use tractography offer better outcomes than surgeries performed without tractography. We are also studying how damage to particular brain connections affects brain recovery measured with functional MRI.