Jersey Shore University Medical Center performs awake, singing brain surgery

In August, 33-year-old Jackson resident Kyle Graham, a dad of two, began experiencing headaches, but he just thought he was exhausted, until he suffered a seizure. A trip to the emergency room at Hackensack Meridian Jersey Shore University Medical Center found a brain tumor was causing his headaches and seizures.

Kyle Graham and family.

The news floored him.

“It turned my world upside down. I couldn’t believe it. It was a shock at first. Then, I think once we really took it in, that’s when the emotions started to really come,” he said.

Dr. Nitesh Patel, co-director of neurosurgical oncology at the Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center, told Graham the majority of the tumor could be removed, while preserving his speech with awake brain surgery. To preserve Graham’s speech while removing the tumor, Patel needed Graham awake and talking, as the tumor was near his speech brain network. Patel asked Graham to sing, to allow him to continuously monitor his speech, cadence and rhythm. Graham, the ultimate family man, made a playlist of songs inspired by his family, including the “Frozen” soundtrack in honor of his daughter, Eminem for his son, and, for his wife, their wedding song, Shaina Twain’s “From This Moment On.”

“When my brother came to visit after the surgery, he asked how it went. I told him it was a great time. I was singing, making jokes. He said, ‘How can you explain brain surgery like that?’ and all I could say was it was a great time,” Graham said.

Graham has a glioblastoma, so the surgery is far from the end of his medical journey.

“Removing a glioblastoma is not like removing a rock from the brain. It is more like removing a ball of sand. It is granular, so parts of the tumor remain,” Patel said. “How do you attack the tumor that is left behind? The only way you can really do it is if you could create microscopic little soldiers to go after it. The best way to do that is to use the body’s own immune cells to attack the remaining tumor.”

To attack the remaining tumor, Graham is currently undergoing radiation with concurrent chemotherapy, and is participating in a unique clinical trial using his own cancer cells to combat the remaining cancer and prevent it from coming back. Graham is one of the youngest participants in the Imvax clinical trial.

Hackensack Meridian Jersey Shore University Medical Center is the only hospital in New Jersey that is participating in the clinical trial of a personalized “vaccine” for newly diagnosed glioblastoma, an aggressive type of brain tumor.

The three-year clinical trial, called the 14379-201 GBM study, is open to patients between the ages of 18 and 70 years old who have been newly diagnosed with presumed, resectable GBM and have not yet received any other treatments or had previous surgeries for GBM, with the exception of tumor biopsy. The purpose of the randomized study comparing Imvax vs. placebo study is to determine if the investigational treatment — which is a type of immunotherapy made from tumor cells taken from the patient’s tumor during surgery — extends survival and improves quality of life for patients with GBM.

“This study is unique because the therapy is customized to each patient’s tumor type, using cells taken directly from their tumor,” Dr. Eduardo Correia, medical director of the Neuro-Oncology Program at the Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center and principal investigator for the clinical trial, said. “Although there are currently other vaccine trials available for GBM, they are investigating a ‘one-size-fits-all’ vaccine — not a personalized treatment using the patient’s own tumor tissue.”

Portions of the tumor removed from Kyle’s brain were processed to neutralize them using Imvax’s proprietary platform, Goldspire, loaded into small bio-diffusion chambers, or small tubes, and implanted in his abdomen.

Kyle Graham.

“Simply putting tumor tissue that is still alive anywhere in the body is probably just going to start growing into another tumor. So, instead, what we do is we take the cells, irradiate them, meaning kill them with low dose radiation. Then, we take those cells and we put them into little plastic chambers that are open on one end. They are implanted back into the patient’s body. The chambers are removed after a couple of days, but hopefully the antigens that are released from the dying tumor cells teach the immune system to fight off the tumor,” Patel said.

“The goal is to train your immune system to attack your own tumor specifically. It’s almost like you say, not just attack a house in the neighborhood, attack the house with a specific layout, color and type of shingles,” Correia said. “It’s very specific and that’s why we are hopeful that this vaccine trial can have a higher chance of success.”

“Approximately 80% of patients who are diagnosed with GBM do not survive longer than two years,” Correia added. “Through clinical trials like this one, our goal is to offer the latest treatment options for GBM, find new ways to extend survival and improve quality of life, and offer new hope for patients and their families.”

Graham’s surgery, clinical trial vaccine, as well as concomitant chemotherapy and radiation, are just a part of the comprehensive treatment he is receiving at the Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center. Graham is also seeing a neurologist to deal with his seizures through medication and has a neuropsychologist available to talk about the implications of the diagnosis for him and his family.