"Flipping the Switch": An Interview with Dr. Mark Gilbert, Chief of NIH’s Neuro-Oncology Branch
, by NCI Staff
In November 2014, Mark Gilbert, M.D., became chief of the NIH Neuro-Oncology Branch. The Branch is a partnership between NCI and the National Institute of Neurological Disorders and Stroke. In this interview, Dr. Gilbert talks about the Branch’s priorities and new developments in neuro-oncology.
What drew you to this position?
I came from MD Anderson Cancer Center, where I was the deputy chair of the Department of Neuro-Oncology for 14 years. NIH is an attractive and unique environment because its mission is strictly focused on research, and there are more opportunities to balance clinical care with research activities.
NIH also offers many opportunities for collaboration between basic and clinical scientists, and among scientists across various disciplines. There is tremendous expertise here, including some of the best neuro-immunologists and cancer scientists in the country. Many could have pursued more lucrative careers in the academic or private sector, but they’ve decided to be at NIH to focus on advancing new cancer treatments.
What makes brain cancer particularly challenging to study and treat?
Unlike childhood leukemia, which is largely treatable thanks to new therapies developed in the last 40 years, and more recently the major advances in therapies for melanoma, brain cancer remains difficult to treat.
Brain cancers are complicated because of heterogeneity within each cancer type and the fact that there are 130 different types of brain cancer. The disease affects people of all ages, across all socioeconomic groups, and it rarely has an inherited component. The causes of primary brain tumors are not known. Primary brain tumors remain a big challenge, but metastatic brain tumors—cancers originating from elsewhere in the body—are 10 times more common than primary brain tumors and are often resistant to therapy because patients may already have undergone treatment for the primary tumor.
Until effective treatments are developed, research must focus not only on treating the cancer but also ensuring the best possible quality of life for patients combating the disease.
What are the Neuro-Oncology Branch’s priorities?
The Neuro-Oncology Branch is currently focusing on treatment for primary brain tumors and will eventually expand to study metastatic tumors. Patient care is at the heart of NIH’s mission. The branch conducts clinical trials, measures patient outcomes, and develops best practices in patient care.
We’ll also be focused on conducting basic research in areas that show promise for developing new treatments. An example is new technologies that will improve molecular characterization of tumors and allow better diagnostics and better-targeted treatments.
Immunotherapy is another area of great promise. It’s already proven to be one key to effective treatment of melanoma and lung cancer and is showing promise for several other cancers. There is also evidence that brain tumor metabolism is fundamentally different from that in normal cells, which means that signaling pathways related to energy production could be exploited to target cancer cells.
To link our clinical and basic research efforts, we’ll also be developing and testing therapies in model systems, such as cell lines and mice. These model systems are key for translating research findings from the lab bench to the patient’s bedside. Some dog breeds are known to have high incidences of brain tumors, and collaborations with the veterinarians at the NIH Clinical Center could help us identify the genetic basis of brain tumors and test new treatments.
We’ll also monitor patients’ responses to treatment and use that information to develop laboratory experiments. Thus, translational research goes in two directions: from bench to bedside and back.
What projects are currently being developed in your branch?
A new immunotherapy trial is about to launch, and several more trials are being developed. In line with the Precision Medicine Initiative that was recently announced, efforts are focused on developing agents that target specific signaling pathways.
Genomic profiling of patients’ tumors and healthy tissue may eventually allow clinicians to not only identify the most appropriate drugs to target the disease in an individual patient but also take into account the patient’s susceptibility to toxic side effects.
What are some exciting new therapies or diagnostic tools in neuro-oncology?
New imaging technologies are allowing clinicians to monitor tumors more accurately and rapidly, and radiologists have developed better software to compare images. Eventually, progress in imaging will lead to the development of imaging biomarkers for tumor growth and metabolism, which will allow clinicians to rapidly assess whether a treatment is working.
We’ve made small incremental improvements in the treatment of brain cancer. A historical perspective on other cancers shows that a revolutionary treatment can very quickly change patients’ prognoses. For example, immunotherapy has resulted in higher survival rates among melanoma patients today than a few years ago.
We need to “flip the switch” for brain cancers in the same way. Of course, we don’t know how much time or how many resources that will take, but we are very optimistic that with collaborative efforts we will make great progress.