Hope for Pediatric Patients with Brain Tumors

When young patients get the devastating diagnosis of a brain tumor, their families want to know what treatment options they have to pursue. Pediatric neurosurgery specialists like Dr. Michael DeCuypere is not only trained in minimally invasive neurosurgery to remove tumors, but he is also among the few pediatric neurosurgeons in the country who is studying new ways to diagnose and treat them. In this conversation, he discusses the surgeon’s role in treating pediatric brain tumors and the potentially game-changing research he is leading now in this area. Learn more about Neurosurgery at Lurie Children's

Featuring

Michael DeCuypere, MD, PhD 

Dr. DeCuypere’s (pronounced di-cy-per) clinical interests include pediatric brain tumors and minimally invasive neurosurgery, and his research interests focus on developing new treatment modalities for tumors in clinical trials.  
 
Learn more about Michael DeCuypere, MD, PhD

Topics Covered 

  • Surgery alone may cure a brain tumor, sometimes, when the tumor is considered low-grade or benign. However, it is more common for a child to need other forms of treatment for a brain tumor after surgery, such as chemotherapy or radiation.
  • A passionate researcher, Dr. DeCuypere has both an MD and a PhD, the latter of which helps him be a good scientist and produce good data that can ultimately help improve care for patients.
  • Dr. DeCuypere’s current research at the Stanley Manne Children’s Research Institute involves examining DNA signatures that may be present in bodily fluids like blood that will help diagnose and follow brain tumors. In another study, he is looking at the immunobiology of pediatric brain tumors to potentially help a patient’s own immune system fight their cancer. 

Additional Reading 

Transcription 

Dr. Michael DeCuypere: Even in the past 10 years, we have really advanced the survival of a handful of tumors to 80%, 90%, which is amazing for a malignant brain tumor.

(Host) Maggie McKay: Finding out you have a condition as serious as a brain tumor is sobering enough. But as a child hearing that news, it's frightening. When young patients get the devastating diagnosis of a brain tumor, their families want to know what treatment options they have to pursue. Pediatric neurosurgery specialists like Dr. Michael DeCuypere, our guest today, is not only trained in minimally invasive neurosurgery to remove tumors, but he is also among the few pediatric neurosurgeons in the country who is studying new ways to diagnose and treat them. So let's learn more about how Ann & Robert H. Lurie Children's Hospital of Chicago is leading the way in pediatric brain tumor research and surgery with Dr. DeCuypere and find out about the surgeon's role in treating pediatric brain tumors and the potentially game-changing research he is leading now in this area.

This is Precision: Perspectives on Children's Surgery, the podcast from Lurie Children's Hospital. I'm your host, Maggie McKay. Dr. DeCuypere, thank you so much for being here today. What an honor. To start, would you please introduce yourself?

Dr. Michael DeCuypere: Sure. I'm Mike DeCuypere. I'm a pediatric neurosurgeon at Lurie Children's Hospital in Chicago, and I specialize in brain tumor surgery.

Maggie McKay: And as a specialist in pediatric brain tumors and minimally invasive neurosurgery, can you tell us about your role in treating young patients with a brain tumor?

Dr. Michael DeCuypere: Sure. So my role as a neurosurgeon usually begins with the families early in the course of treatment, usually one of the very first physicians they meet typically in an emergency room after they've had a scan of their child's head performed that shows a brain tumor. And so they meet the emergency room doctor, and then they call neurosurgery and then we walk in. And so I'm constantly, you know, finding myself in situations where the family's in a state of shock, and they're trying to wrap their minds around what's going on, how did this happen, how did we get here. And I always try to go as slow as I can at the beginning and explain what we see and talk about the next steps and how we're going to diagnose the child and treat the child and, you know, move along the road that will begin at that moment in treating the brain tumor.

Maggie McKay: That's got to be so emotional for both sides.

Dr. Michael DeCuypere: Very much so. You know, I always want this conversation at the beginning to not be the only one I have with the family, because, you know, I would come back later on and there's 25 more questions after they've spoken with family and other friends and such. So, you know, I try to walk through the imaging with the family, give them the best possible idea of what's coming, you know, a day at a time. Try not to put the cart before the horse, so to speak, and walk them through how the next several days are going to go.

Maggie McKay: And help us understand what surgery is like for a young patient with a brain tumor. Can it cure a patient? What conditions make it more complicated to remove a tumor?

Dr. Michael DeCuypere: So, sometimes surgery alone can cure a brain tumor. Not all the time. This only is true for brain tumors that we consider low-grade or sometimes benign brain tumors. In that situation, if you can remove the tumor in its entirety or what we call a gross total resection, then the child can be cured. And that may be the only treatment that they require moving forward. That's a great scenario and we're very happy when that can be the case. However, the majority of brain tumors, surgery alone is not enough. Very commonly in children, they require other forms of treatment after surgery, such as chemotherapy or radiation in some form or fashion. And also, surgery can entail a couple different things. For example, sometimes if a brain tumor is located in a very eloquent or important part of the brain, full surgical resection may not be an option. In those scenarios, we can only really do a biopsy to diagnose or obtain pathology for the tumor. That's most common in the setting of a tumor of the brain stem or diffuse tumor of the brain stem. Certain tumors of the brain stem can actually do surgery on. But the more serious tumors of the brain stem, unfortunately, we're limited in our surgical approaches to those lesions.

Other times our goal is to remove the entirety of the tumor or a gross total resection. But if it's a malignant tumor, a child may still need chemotherapy and radiation treatments in an effort to make sure that the tumor doesn't come back or grow back from microscopic cells that still may be present within the brain or the fluid within the brain.

Maggie McKay: Wow, that sounds like quite a process over time. You also hold the title of Director of Translational Research and Clinical Trials in Neurosurgery at Lurie Children's. What does this mean?

Dr. Michael DeCuypere: Well, the idea of translational research is research that you can translate from the bench to the bedside or from your research laboratory to the patient's care. And so that's research that we can turn into clinical trials or new medications or new therapies for children. And obviously, clinical trials are the way we test these new therapies and drugs in the real world. It's how we develop safety and dosing regimens for different chemotherapy drugs in an effort to produce good science with meaningful results that we can take into the clinic. My title here just means that I'm the person who oversees our translational research efforts within our division here at Lurie. And I also am involved in developing new clinical trials here at Lurie Children's as a primary site, but also at Lurie Children's as an accessory site with other institutions.

Maggie McKay: And Dr. DeCuypere, can you tell us about your background? You've said you are inspired by the children you treat. How did you get into this field?

Dr. Michael DeCuypere: Sure. Well, in medical school, I entered a special educational track, so to speak, for what we call dual-degree physicians or the physician-scientist training program. What that means is I worked on my MD and I got a PhD sort of at the same time. But they make the track integrated so that I can study medicine and learn science in a coordinated fashion, so to speak. This takes a little bit longer. I always joke a bit and say it's two degrees and twice the time. But what it does is it both gives me a medical education as a physician. But also it teaches me about how to be a scientist and how to form hypotheses and develop experiments and interpret results in a way that a lab scientist would who is not a clinician. And so that's where we get the idea of the clinician-scientist track.

So after I spent that time in medical school, I then entered neurosurgical residency, which is where you learn the skill and the art of brain surgery. That's a long road and it takes seven years just to learn the clinical side of neurosurgery. So during my clinical training in my residency, I had the privilege of working under some mentors in pediatric neurosurgery and they had a profound influence on me. And not only did I enjoy working with them and have, you know, that inspiration that they offered to me, but I also really realized I liked working with children and families. And so, I decided I'd like to pursue pediatrics as a subspecialty.

So after my residency, I then did a couple fellowships actually. I did a fellowship in Australia in Sydney, under Charlie Teo, who is a world-renowned minimally invasive neurooncology surgeon in Australia. And then, I returned to United States and then did a formal pediatric neurosurgery fellowship, which is an additional year. And then, after my fellowship at St. Jude in Memphis, then I entered the world of being an attending. And eventually, it has led me here to Chicago.

Maggie McKay: Dare I ask how many years that took, all of that, what you just told us about?

Dr. Michael DeCuypere: Well, so if you say, okay, college is four years, I did eight years of medical school, seven years of residency, and then another year of fellowship. So it's say 20 years of school and training to get to sort of where I am now.

Maggie McKay: Oh, my goodness. Well, you are definitely dedicated. That is for sure. You touched on this a little bit, but you have both a medical degree and a PhD in neuroscience. So how does a PhD enhance your expertise in this field?

Dr. Michael DeCuypere: So as I sort of talked about a little bit, the PhD really teaches you how to be a scientist and think like a scientist and interpret data like a scientist. Medical school teaches you how to be a physician, a clinical physician. And the other side of being a physician scientist, you either have to learn on your own and there are very many, very successful scientists who don't have a PhD, but having the PhD offers a sort of formal education in being a good scientist and producing good data. And so, there are a handful of us in pediatric neurosurgery who have a PhD in addition to an MD. And I definitely think it helps us be better at what we do and I think generate good data that helps patients.

Maggie McKay: Can you tell us some details about the current research you are involved in at Lurie Children's and the Stanley Manne Children's Research Institute?

Dr. Michael DeCuypere: Sure. So I have a few I'd like to highlight that I'm most excited about. One is research in collaboration with Northwestern and specifically Dr. Craig Horbinski, who is the head of neuropathology at Northwestern. This is a study looking at DNA methylation profiling. And what that means in sort of lay terms is investigating DNA signatures that may be present in bodily fluids, such as blood that will help us to diagnose and follow brain tumors. So for example, the current study we're working on, we draw blood from patients with brain tumors. And then, we try to correlate the DNA signature within the blood to that within the tumor in an effort to develop a test where we might not have to do a biopsy of a brain tumor to reach diagnosis.

The idea behind this study is that brain tumors tend to release small amounts of DNA as they grow and as the cells divide and turn over into the blood. And we have technology available at Northwestern specifically that is able to detect small fragments of that DNA. And it can offer a very unique signature that can give us a very accurate idea of the nature of a brain tumor within the nervous system. And that's very exciting because it would be great to be able to offer patients and children a diagnosis without having to do a biopsy or perform surgery. Now, it may not circumvent the need for surgery, obviously, but it would definitely offer a minimally invasive or non-invasive test to get a diagnosis.

Another way we could harness this technology is to follow patients over time. So if a patient, for example, has a malignant brain tumor, you know, we're always worried about them returning or growing back. I work with a lot of families and we do followup imaging and there may be a blip on the scan and we're sort of wringing our hands and wondering, "Well, is it tumor? Is it scar tissue? What is it? Should we be worried?" And it would be great to be able to say, "You know what? Let's draw some blood and see if we can detect any tumor DNA in the blood," and that might give us some answers, be able to either offer some hope or offer an opportunity to intervene sooner if a tumor's growing back before we have, you know, the full imaging evidence, so to speak.

So I'm very excited about this research project. We just received a $300,000 grant from a private institution to pursue this. And we're looking very forward to being one of the first sites in the world to do this on pediatric brain tumors.

Maggie McKay: That is wonderful.

Dr. Michael DeCuypere: Oh, yes. Thanks. Like I said, I'm very excited about it and I think it has the opportunity to be really impactful for diagnosis of these tumors. Another study that I'd like to highlight is research project that involves examining the immunobiology of pediatric brain tumors. And what that means is what type of immune cells or white blood cells, for example, from the patient actually enter the tumor and the tumor environment. For a long time, we thought that the brain was an area of your body, that your white blood cells and your immune system couldn't go. Well, we've since figured out that is not true and that you have white blood cells and immune cells within your nervous system all the time. And they can actually help fight cancer and brain tumors. However, certain malignant brain tumors are very difficult to treat and they can actually influence your immune cells by hiding from them, so to speak, or turning them off from their activation states. And so, what we would like to do is to find ways to harness a patient's own immune system to help fight their cancer.

In order to do that, we need to learn more about how the immune system interacts with brain tumors and what the brain tumor is doing to evade the detection by your immune system. This has been done to some degree in adult patients and specifically in adult high-grade gliomas, which are very difficult to treat, but actually very little has been done in the pediatric realm. And so we envision Lurie Children's, Stanley Manne and Northwestern as being a national or even global site for immune target detection. So what we want to do is create a library database of these pediatric brain tumors and what type of immune cells are found in them, how do the immune cells interact with these tumors, how are these tumors hiding from the immune system. And if we can develop a database and a repository of that information, then we're hoping that other sites can use our information to create drugs that can help activate the immune system or to turn on certain blood cells that might help fight these cancers. And I think we have the patient availability here and we have the laboratory space and the scientists to help make that work. And so we are in the process of getting this off the ground. We've already enrolled over 50 patients with various types of brain tumors and we're examining the immune composition of those tumors. And as we get more patients enrolled and we get more data, we can start offering more detailed maps of how these tumors look from an immune standpoint.

Maggie McKay: That is amazing. I can hear the enthusiasm in your voice. It just sounds amazing. How has your field advanced from 10, 20 years ago? What does the future hold?

Dr. Michael DeCuypere: Actually, a lot has happened in the past, even five to ten years, to be honest; twenty years, definitely. But there's been a molecular sort of revolution in the diagnosis and classification of pediatric brain tumors specifically, but all brain tumors in general. And by that, I mean, we've discovered through the analysis of DNA and RNA from these tumors of hundreds and hundreds of patients that certain tumors that we thought represented a single disease entity actually represent several within the umbrella of type of tumor, so to speak. And so nowadays, when we take out a brain tumor and we have the tissue, not only are we looking at it under a microscope traditionally as a pathologist would, but that pathologist now is doing genomic analysis, proteomic analysis, DNA, you know, methylated DNA analysis on these tumors. And we're finding that there are, you know, several varieties of malignant brain tumors where we thought there were just a few before. And even in my short career in neurosurgery to date, the names of tumors are changing because we realized that we had misnamed them before. And then, we've got more information now to look at their lineage and how they were formed and the tissues that they come from. And I think this is only going to get more specific as time goes on. I think the importance of that is with that information, that molecular revolution in brain tumor diagnosis, it has allowed us to develop what we consider targeted therapies. So therapies that can target very specific molecular pathways that these tumors utilize to grow and divide uncontrollably. And for a handful of brain tumor diagnoses, it has really revolutionized chemotherapy and the survival of these tumors. And so even in the past 10 years, we have really advanced the survival of a handful of tumors to 80%, 90%, which is amazing for a malignant brain tumor. Unfortunately, there are a few tumors that are still quite lethal and their diagnosis is a terrible thing. And those are the tumors that we're working diligently on to try to harness all the science that we can to develop new therapies and ways to diagnose and treat these tumors. So we definitely have a ways to go, but it's amazing just in my short career how far we've come.

Maggie McKay: It sounds like there's a lot of encouraging news in here. So what gives you hope for pediatric patients with brain tumors?

Dr. Michael DeCuypere: You know, the thing about operating on children that is most gratifying to me is to see a child go through so much surgery, chemotherapy, radiation, and to see them come out on the other side. And it's like one of those things that, you know, if you watch a child go from beginning through all of this, it's like a life-changing thing to see. Here at Lurie, we have a bell in the oncology department and when a child has completed their therapy, meaning that they're done, they're in remission, they have no disease, they can go over and they ring the bell and it really like brings tears to your eyes because they're so brave. And, you know, I always think to myself, "Wow. I don't know if I could do that." There's this young child who's come so far. It's amazing that they just don't give up and that's super inspiring to me and it's why I get out of bed in the morning and come do what I do.

Maggie McKay: I'm going to get tears just hearing about that bell, doctor. My goodness. But I love that they do that. Dr. DeCuypere, this has been not only fascinating and educational, but so hopeful. We appreciate you sharing your time and your expertise. And thank you so much for your important work and your continued research for children with pediatric brain tumors.

Dr. Michael DeCuypere: It's been great. It's my pleasure. Thank you very much.

Maggie McKay: Thank you so much. To learn more, go to luriechildrens.org/neurosurgery or make an appointment by calling 1-800-KIDS-DOC. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. Thank you for listening to Precision: Perspectives on Children's Surgery, the podcast from Lurie Children's Hospital. I'm your host, Maggie McKay. Be well.

 

 

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