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Henry Friedman, MD
HenryFriedmanMD (Physician - Neuro-Oncology (Verified) )| Communities: Brain Cancer | Answers: 8 |
| Member Since: May. 2012 |
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Professional Statement
Henry S. Friedman, MD, is Professor of Neuro-Oncology at Duke University Medical Center. He is an internationally recognized neuro-oncologist with a career-long interest in the treatment of children and adults with brain and spinal cord tumors. He has written hundreds of articles on both the clinical and laboratory investigation of these neoplasms.
Professional Info
Credential: MD
Primary specialty: Neuro-Oncology
Medical school: SUNY Upstate Medical University College of Medicine
Residency: SUNY Upstate Medical University of Syracuse
Internship: SUNY Upstate Medical University of Syracuse
Fellowship: Duke University Medical Center
Areas of expertise: Adults and children with primary and secondary brain and spinal-cord tumors; laboratory and clinical design of new therapeutic strategies utilizing alkylating agents, monoclonal antibodies, small-molecule inhibitors, gene therapy, vaccines and other approaches.
Research interests: Biology and therapy of adult and childhood central nervous system malignancies, particularly high-grade medulloblastoma, glioma, and ependymoma.
Hospital affiliation: Duke University Medical Center
Practice address:
047 Baker House Trent Drive DUMC Box 3624
Durham, NC
27710
Practice phone number: (919) 684-5301
HenryFriedmanMD Activities
There are a number of tumors for which chemotherapy is routinely employed, including virtually all malignant brain tumors. However, chemotherapy may also be employed for lower grade tumors particularly under certain settings where molecular analysis suggests it would be effective. For the precise answer to this question, the exact nature of the tumor, the clinical condition of the patient and the function of the various organs of the patient will decide if chemotherapy should be employed.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
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10 months ago
Immunotherapy is one of the more exciting newer strategies in the treatment of patients with brain tumors. There are a number of vaccines that are either focused on a specific molecular target in the tumor or that are made to a so called tumor homogenate. Both of these approaches are appearing to produce benefit in selected patient populations and I personally believe that there will be an ever increasing role for immunotherapy for patients with brain tumors.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
Answer |
10 months ago
Tracking a patient with a brain tumor involves periodic careful physical examinations focusing albeit not exclusively, on the nervous system. Magnetic resonance imaging is the standard approach for following a tumor though other studies such as MRI spectroscopy and PET scans as well as newer imaging modalities may play a role. Following a patient for chemotherapy include monitoring of blood counts, liver functions, renal functions, electrolytes, and common endocrine parameters such thyroid function. The analyses are chosen based on the agents that the patient is receiving. Finally, there are certain agents which can produce pulmonary or cardiac side effects and these must be monitored in those settings as well.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
Answer |
10 months ago
The current role for genetic analysis of brain tumors as a means of achieving a more precise therapeutic intervention is still in its infancy. There are a number of genetic studies that clearly have a role such as the methylation status of the promoter of the MGMT gene which is prognostic but not predictive for the role of temozolomide in the treatment of malignant glioma. Furthermore, other genetic markers such as the absence of 1p19q can predict for sensitivity to temozolomide. Additional markers such as IDH1 and IDH2 are prognostic for a better outcome with the use of any intervention. However the Holy Grail we are all searching for is to use individualized tumor genome analysis to more rationally choose therapeutic strategies which will produce better outcomes in our patients. This has yet to be achieved and although has proven to be beneficial in other tumors, the extraordinary breadth of molecular aberrations seen in the glioblastoma multiforme may make this a very difficult challenge. Nevertheless it is work that must be conducted if we are going to achieve our goal of personalized medicine in the treatment of patients with brain tumors.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
Answer |
10 months ago
There is only one polymer wafer implant that has been approved for the treatment of patients with brain tumors. This is Gliadel which is the trade name for a wafer that releases BCNU into a tumor crater. It has been approved by the FDA for both newly diagnosed and recurrent malignant gloma and clearly produces a producible albeit modest increase in survival for these patients. Accordingly, there is a place for these wafers in the treatment of patients with these tumors.
Furthermore there are a number of clinical trials that are incorporating the use of Gliadel wafers into their therapeutic regimens. The role of Gliadel in these protocol settings is still being defined and represents a way to achieve concentrations of BCNU at the tumor site far higher than could be achieved if the drug was delivered by its traditional intravenous route of administration. To utilize these wafers, the tumor must be completely resected and not have a major connection to the ventricular system. Furthermore it should not be located near a very eloquent site since the local inflammation that is commonly seen following implantation of the wafers can produce significant morbidity. However if utilized in the appropriate setting, Gliadel wafers can increase survival and its role in future trials is still being investigated.
Furthermore there are a number of clinical trials that are incorporating the use of Gliadel wafers into their therapeutic regimens. The role of Gliadel in these protocol settings is still being defined and represents a way to achieve concentrations of BCNU at the tumor site far higher than could be achieved if the drug was delivered by its traditional intravenous route of administration. To utilize these wafers, the tumor must be completely resected and not have a major connection to the ventricular system. Furthermore it should not be located near a very eloquent site since the local inflammation that is commonly seen following implantation of the wafers can produce significant morbidity. However if utilized in the appropriate setting, Gliadel wafers can increase survival and its role in future trials is still being investigated.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
Answer |
10 months ago
The side effects from chemotherapy are obviously dependent on the nature of the chemotherapy chosen for the patients’ treatment. Therefore it is impossible to list a complete compendium of side effects without specifying which chemotherapy agents are chosen. Nevertheless the chemotherapy side effects can impact on virtually any organ in the body including bone marrow, liver, kidney, lung and heart. Moreover non-specific side effects such as fatigue and nausea also may be addressed. Optimally, a patient will be told the side effects of any therapy they are receiving and then given a written description of them to take home.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
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10 months ago
A patient with a brain tumor, either newly diagnosed or recurrent, should expect their first meeting with a neuro-oncologist to understand that this is going to be a team effort. The neuro-oncology team will not dictate care but rather work with the family to provide a meaningful mutually understandable approach to the therapy of the tumor. Information regarding the natural history of the tumor, reasons why there is hope for the patient to survive and the therapeutic options should all be presented. Moreover since a well-trained neuro-oncologist should not try to imitate a restaurant by merely offering choices the patient then chooses, the neuro-oncology team should make a firm recommendation as to what they recommend should be used. Options should be provided and the family should be offered specific recommendations and not be expected to choose therapy without that input.
Finally, the complete resources of the program which are available to the patient should be presented which obviously include far more than just medical management. This can address issues that include financial concerns, intra-family dynamics and all other issues related to living with a brain tumor.
Finally, the complete resources of the program which are available to the patient should be presented which obviously include far more than just medical management. This can address issues that include financial concerns, intra-family dynamics and all other issues related to living with a brain tumor.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
Answer |
10 months ago
The most important information that we can provide to a patient with a newly diagnosed brain tumor is that there is hope. We firmly believe in The Preston Robert Tisch Brain Tumor Center at Duke that all patients are potentially curable until proven otherwise. Indeed there is an ever-increasing minority of patients with the most aggressive of the malignant brain tumors, the glioblastoma multiforme, who are surviving for over a decade, with no evidence of disease. We admit that this is a minority of the patients but make sure that the families understand this is an increasing minority. This foundation of hope is the single most important information we can provide and is based on the reality of newer advances that have come and are coming in the treatment of these tumors.
New answer by HenryFriedmanMD (Physician - Neuro-Oncology (Verified))
1
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10 months ago
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