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MUSC Pediatric Brain Tumor program aims to find cures, help families
By Dawn Brazell | News Center | February 24, 2014
A photo of a bald teenager hangs in Amy-Lee Bredlau’s office.
“This patient just finished her chemotherapy. She’s bald. She’s beautiful. She went to her homecoming dance this fall and was voted homecoming queen with no hair,” said Bredlau, M.D., director of the Medical University of South Carolina’s new Pediatric Brain Tumor Program. “She’s doing beautifully. She’s a medulloblastoma patient. She’s in that group of people who 50 years ago had a devastating tumor, but now she has a fabulous opportunity. I really think she’s going to have a long, healthy, happy life. ”
Bredlau, a pediatric neuro-oncologist, beams. She keeps these photos and cards posted in her office as a reminder to keep pushing the envelope in her field. Not all patients have that same cheery prognosis. Take a tow-headed boy who just celebrated his third birthday but has a fatal type of brain tumor.
“He is one of the most adorable little boys that I’ve met, and his parents are absolutely delightful. What they have been through since I’ve met them just breaks my heart. You can’t help but share some of that intensity,” she said of what it’s like to treat children with brain tumors and why she is so glad MUSC now has a specialized program to serve these families.
“You become very emotionally bonded with the family. It hurts twice as much to watch someone go through this so undeserved. No child deserves cancer, let alone a fatal brain tumor. It’s just flat out unfair. We all know that. It does break my heart to watch it happen. It’s always the worst story – every single patient. It’s always the worst because it’s theirs.”
Bredlau’s role as program director is to coordinate medical care with the team that includes herself, two radiation oncologists, a pediatric neurosurgeon, a neurology nurse practitioner and a neuroradiologist. “Families have enough on their plates without being shuffled from one expert to another on separate visits. Families are thrown into a world they do not understand that’s incredibly complex – like a rat in a maze. They are thoroughly overwhelmed by it. Without a guide through that path, it can be even more terrifying than it otherwise has to be.”
A team approach is critical to how the program tries to improve the quality of care, she said. They are not just relying on one “phenomenal brain” to come in with a treatment plan.
“We’re able to talk about the patients as a team and make sure we’re not missing anything huge. I may not think about seizures in a patient when I’m trying to treat a brain tumor, which is what I do, because I have things that are more pressing. But if I have a neurologist there who can say, ‘You know what? They are having more seizures than they really should, and I can fix that for you while I’m here.’ That is fabulous – not to mention the legwork it can save for the families who are coming from all over the state to see me.”
Bredlau, who also holds a master’s in clinical investigation and is well on her way to becoming a nationally-recognized translational researcher in developing new therapies in children with brain tumors, splits her time between clinical work and research. She has worked closely with MUSC’s Jaqueline Kraveka, D.O., to design and participate in a novel clinical trial that is open nationwide through the Neuroblastoma Medulloblastoma Translational Research Consortium. The consortium is a group of 18 universities and children’s hospitals that offer a nationwide network of childhood cancer clinical trials.
Praising the consortium, Bredlau said it fosters research from a group of closely collaborating investigators who are linked with laboratory programs developing novel therapies for high-risk neuroblastoma and medulloblastoma.
She’s working on a molecular-guided therapy protocol for patients who have tumors that are coming back and regrowing instead of responding like they should.
“We can do a biopsy of the tumor and have it analyzed molecularly and take that information and guide the next therapy based on what the tumor seems to best respond to. That’s what I find really exciting now.”
Bredlau, as an early phase drug developer, specifically targets how she can improve the treatment and cure of pediatric brain tumors. “I want to know I’m making a lasting impression beyond the lives of the patients whom I treat and care very deeply about. But beyond them, I want my impact on medicine to last for the next decades hopefully.”
Though she never imagined herself in this field, she wanted to be a pediatrician, she has no doubt it’s where she needs to be. Research is critical to saving these children. For example, in the 1960s, 8 percent of children survived when diagnosed with medulloblastoma, but now those children have a 70 to 80 percent overall chance to survive. MUSC’s Edward Kosnik, a pediatric neurosurgeon, was part of the research that made that critical change, she said.
“To increase survival by tenfold in only 50 years is really amazing, and there definitely are still more children like that who need changes like that in their diagnoses. “
The patients are her driving motivation.
“They are phenomenal, but they need more help. We don’t have enough to offer them. The tumor that bothers me the most – that I think about the most – is uniformly fatal and kills everybody that has it. That’s not OK. There are too many smart people and too many good medicines out there to allow children to die.”
Bredlau, who loves a challenge, chose neurooncology because of its complexity and need for breakthroughs in treatment options.
“It’s prime real estate. If you have a tumor in your foot, it’s easy to get to. The worst-case scenario, you lose your foot, but you stay alive. That is not an option for your brain in any way, shape or form, so the limitations are huge.”
Add to that the blood-brain barrier that stops most chemotherapy from getting into the brain from the blood system, and there’s another layer of complication. Radiation, another treatment option, can have some significant, long-lasting effects if too much radiation gets to the brain. “It’s a tricky, tricky world, but I like the challenge of how to get the best result for a patient with the least cost to them.”
Bredlau said she just wants to get the word out that MUSC’s Pediatric Brain Tumor Program is available and thriving.
“We have some fabulous people on the team and we’re proud to offer this to the community and surrounding areas as well. What I want people to understand is if, by some horrible, horrible chance, your child is diagnosed with a brain tumor, you’re not doing this alone.”
For more information about the program, visit this website.