GARDEN STATE NEUROLOGY & NEURO-ONCOLOGY, PC
Sumul N. Raval, M.D., D.A.B.P.N.
Board Certified in Neurology (A.B.P.N.)
Clinical Insturctor, R.W.J. Medical School - UMDNJ, Clinical Associate - CINJ

100 State Highway 36 East, Suite 2P, Second Floor, West Long Branch, NJ 07764 Phone: (732) 229-6200

Fax:  732-229-6201
9 Hospital Drive, Suite C24, 2nd Floor, Toms River NJ 08755 Phone: (732) 341-0200 Fax: 732-229-6201


 

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Press Release

Experimental therapy shrinking brain tumors

Posted by the Asbury Park Press on 10/8/06

BY BOBBI SEIDEL
STAFF WRITER

LONG BRANCH — An experimental treatment in use at Monmouth Medical Center — one of only two sites in the nation that have been studying the therapy for more than a year — has prolonged the life of a Manalapan man diagnosed with a deadly brain tumor and is creating hope for other brain tumor patients.

"The response of malignant brain tumors in the last 50 years to chemotherapy has been very marginal. We used to say, "Nothing works for a brain tumor.' Now we can say something works," says Dr. Sumul N. Raval, study leader. "This research is very, very exciting."

The treatment combines two drugs normally used only for other types of cancer. A year of receiving the treatment has tremendously reduced the brain tumor of Jack Steinberg, 45, of Manalapan, says Raval, medical director of the David S. Zocchi Brain Tumor Center at the Leon Hess Cancer Center at Monmouth Medical.

"I feel positive," says Jack Steinberg's wife, Cheryl, 45, who spoke for the couple while her husband continues recuperating.

"This is not a cure," Raval says. "So far, it is experimental because both drugs are not FDA-approved for brain tumors. But this is a major step. This is going to open up the doors to new treatments.

"All of my patients have responded after the first two cycles of treatment, although not everyone has responded like Jack Steinberg," Raval says. "This is not anecdotal reports. We have this response (to the treatment) continually.

"With more people using it and more literature on it, it will become a new standard of care," Raval says, adding, "I want people to know they can get help."

Steinberg is one of 15 patients in Raval's study. The other study is at Duke University in North Carolina.

"This is a great advance that will help a lot of people," says Dr. Allan Tunkel, chairman of internal medicine at Monmouth Medical of Raval's work. "I think in his role as a neuro-oncologist — one of the few in New Jersey and in the country — what he's doing is amazing."

Jack Steinberg's treatment began in August 2005, after it was discovered he had a rapidly growing malignant brain tumor — a gioblastoma multiforme, or GBM. This is the most common malignant brain tumor, Raval says.

"The prognosis for him was extremely limited," says Raval, a board-certified neurologist and neuro-oncologist affiliated with Monmouth Medical Center for about a year. He previously was at Jersey Shore University Medical Center, Neptune.

The treatment combines Irinotecan, a chemotherapy, and bevacizumab, a monoclonal antibody that blocks receptors that allow blood vessels to grow in the tumor.

"Chemotherapy destroys the rapidly developing cancer cells in the body," says Raval, 37. "Bevacizumab prevents new blood vessels from forming.

"When you have a brain tumor, lots of new blood vessels form, carrying lots of oxygen and nutrition to the tumor cells. The cells, without nutrition, die," he says.

Until now, Irinotecan was used for lung cancer and bevacizumab for colon or rectal cancer.

"When I started using this combination, there was only a small abstract published in The Journal for Neurology in May 2005," Raval says. "Duke decided to do a small study. We also decided to do a study. We did not have information about Duke's study at that time."

Steinberg's case is an example of what the new treatment can do.

In April 2005, Steinberg had undergone surgery in Manhattan to remove an initial tumor, which was diagnosed after he experienced dizziness, blurred vision, headaches and personality changes.

In July 2005, he had a very small tumor remaining, Raval says.

"In August, he grew a massive amount of tumor. That's when we put him on the combination," Raval says.

Treatments were given that August and September, and an MRI was done in mid-September.

"I could not believe my eyes," Raval says of what the MRI showed. "I checked everything 10 times before I broke the news to the family. There was very little of the tumor left. More than 95 percent of the tumor had responded, like it had melted away.

"This was an unreal response for a rapidly progressing brain tumor."

Jack Steinberg remains in remission, Raval says. While recuperating, Steinberg has taken a leave from the auto-parts business he operates with his brother.

Raval's data on the study will be published in the Nov. 16-19 issue of The Journal of Neuro-Oncology.

ON THE WEB: Visit our Web site, http://www.app.com/, and click on this story for a link to Monmouth Medical Center.

Bobbi Seidel: (732) 643-4043 or bobbi@app.com
Copyright © 2006 Asbury Park Press. All rights reserved.
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Another Press Release

Neurologist from Monmouth and Community Medical Centers
Gives Advice about Traumatic Brain Injury 

Toms River, March 17, 2006 -- Brain injury is a major cause of death for adults and more U.S. children die of brain injury than any other cause. Each year in the United States, about 1.4 million people sustain a brain injury, according to the Brain Injury Association of America. Of those, 50,000 die; 235,000 are hospitalized; and 1.1 million are treated and released from an emergency department.  Currently, there are at least 5.3 million Americans living with a disability because of a brain injury and the cost to society is estimated at $56.3 billion annually.

 “Brain injury is unpredictable in its consequences,” says Sumul N. Raval, MD, a Board Certified neurologist and neuro-oncologist on staff at Monmouth and Community Medical Centers. “Brain injury affects who we are, the way we think, act, and feel. It can change everything about us in a matter of seconds.”

Traumatic brain injury (TBI) can be caused by a blow or a jolt to the head, which causes damage to the brain. TBI occurs when an outside force impacts the head hard enough to cause the brain to move within the skull or if the force causes the skull to break and directly hurts the brain. Injuries can range from a mild concussion to severe injury, coma, and death, Dr. Raval notes.

Not all blows or jolts to the head result in a TBI, he observes. The severity of such an injury may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness after the injury. A TBI can result in short or long-term problems with independent function.

“If you have a mild concussion, you may have no long-term side effects. If you have a moderate to severe brain injury, side effects can range from headache and confusion to personality changes and seizures,” says Dr. Raval.

TBI can cause a wide range of functional changes affecting thinking, sensation, language, and/or emotions. It can also cause epilepsy.  

Half of all brain injuries are due to transportation-related accidents. These can include car, motorcycle, and bicycle accidents, as well as injuries to pedestrians. About 20 percent of brain injuries are due to violence. This can include firearm use and child abuse. For people age 75 and older, brain injuries are most often caused by falls.

“Severe brain injuries affect both the injured people and their families. It is a period of great trauma and change,” Dr. Raval states.

A brain injury is a true emergency and treatment begins at the time of the accident or incident. Medical personnel try to stabilize the patient and work to prevent further injury. They make sure oxygen gets to the brain, that there is enough blood flow and blood pressure is controlled.

Many of the severely injured people will need surgery. This may be to remove a hematoma, which is bleeding in or around the brain. Some people may need a ventriculostomy, a procedure that drains fluid from the brain.

After the emergency treatment, people may receive care in an intensive care unit in a hospital. Once they are stable, they may move to the sub acute unit of the hospital or to a rehabilitation hospital. At this point, people follow many paths toward recovery.

“Fortunately, brain injury is one of the most preventable brain disorders,” comments Dr. Raval. Improved use of car safety belts and child car seats has helped reduce the number of brain injuries. So has greater use of helmets in biking and other sports. Efforts to reduce drinking and driving have also helped.

There have been considerable efforts to recognize and prevent brain injuries in sports. Coaches and parents have learned the signs of concussion. They have also learned that student athletes must get quick medical care.

Dr. Raval states that a person with a suspected brain injury should contact a physician immediately, go to the emergency room, or call 911 in the case of an emergency. 

“The sooner you can get treatment, the greater the chances for a full recover,” he says. 

For more information about traumatic brain injury or to make an appointment with Dr. Raval, please call his Toms River office at 732-341-0200 or his Long Branch office at 732-229-6200.

This page was updated on 01/07/2007