The Brain Tumor Program at Duke was founded in 1937 as one of the first in the United States. Seventy years later, it is one of the largest and most successful programs of its kind in the country. Dedicated entirely to the treatment and cure of brain and spinal tumors in children and adults, The Preston Robert Tisch Brain Tumor Center at Duke combines the resources of a leading research organization with a commitment to the best in patient care. With a staff of more than 250 doctors, nurses, social workers, and staff, more than 6,000 patients have been treated at the center in the last 10 years. The Brain Tumor Center is led by Director Darell Bigner, MD, PhD, Edwin L. Jones, Jr., and Lucille Finch Jones Cancer Research Professor of Pathology; and Deputy Directors Allan Friedman, MD, Guy L. Odom Professor of Neurosurgery, and Henry Friedman, MD, James B. Powell Jr. Professor of Neuro-oncology.

In an interview with Dr. Allan Friedman and Dr. Henry Friedman, who have been at Duke for 33 years and 26 years respectively, they share their thoughts about brain tumors and hope:

What differentiates Duke from other places that treat brain tumors?
Dr. Allan Friedman: There are several key differences. The Preston Robert Tisch Brain Tumor Center is a complete center where we have researchers studying brain tumors from many angles and then implementing what is learned in the clinic. We have some researchers looking at the basic science of cancer stem cells while others are researching the importance of exercise and others are testing new medicines. Second, we are realistic in our approach to treatment and are willing to try new things in order to help the patient. Also, only a few places treat the whole patient. In addition to the physical treatment, we have social workers who help with things such as family support and working through the social and psychological changes a brain tumor brings.

Dr. Henry Friedman: In addition to providing patients with FDA-approved drugs, 66 percent of our adult patients and 75 percent of our pediatric patients are enrolled in clinical trials where they can try the newest—and possibly better—therapies. Nationally, fewer than five percent of adult brain tumor patients are enrolled in trials. In addition, we do what few other brain tumor centers do, and that is prescribe drugs to our patients that have been approved by the FDA for other cancers. These are drugs like Avastin where trials have shown them to be safe and effective for colon cancer and lung cancer. Now, Dr. James Vredenburgh at Duke has shown in clinical trials that Avastin shrinks the majority of recurrent malignant gliomas, the most common and deadly form of brain cancer. Because of the long FDA review process and the fact that few companies manufacture drugs specifically for brain tumors due to the relatively small number of people who have them, this is often the best way of getting safe drugs to patients.

The center’s motto is “At Duke there is hope,” but how do you instill hope in patients with such a serious disease?
Dr. Allan Friedman: We are an upbeat place. We are going to make every attempt to cure every patient we see and we strive to make sure that every patient has the best possible quality of life. Those with the worst brain tumors have an 18 percent disease-free survival of three years, so we know that people can recover. We try our best to push that number higher and give every patient the best chance. This is not false. We have patients leading healthy lives that prove it.

Dr. Henry Friedman: We have the best results in the nation, partially because we think outside the box. Treatments at Duke have been so successful that we will open a brain tumor survivorship center in early 2008. This center is for patients who have been off treatment for at least two years. The center will offer services to help those patients with issues associated with living with a brain tumor. We believe that this is the first center of its kind.

What is your favorite part of the job?
Dr. Allan Friedman: I love working with the patients and their families. Being a brain surgeon, you have a special bond with the patient. You are operating on someone’s brain! You learn a lot about the patient, and it’s always wonderful to see them have a great outcome. In addition, my colleagues are terrific.

Dr. Henry Friedman: I love everything about my job, from taking care of patients to researching new breakthroughs. I love seeing patients and their families have a good outcome. It’s special seeing patients who come to us with no hope end up having successful treatment here with an improved quality of life.