Toronto firefighter back to work after new drug slows ‘incurable brain cancer’

In December 2020, Steven Stefanidis, a 36-year-old Toronto firefighter, was responding to a medical call when he blacked out and had a seizure.

After being assessed by first responders, he was taken to the hospital, where an MRI revealed a tumor. It was diagnosed as a grade 2 IDH mutant glioma, an incurable form of brain cancer.

It came as a complete shock, Stefanidis told Global News.

“Here I was in my early thirties and living my best life with a dream job when I suddenly had a seizure. “I can’t describe what it was like to hear that I had incurable brain cancer,” he said.

“At first I was in shock and couldn’t process the information because it was heavy. But overall the neurosurgeon I met was very relaxed and confident. I trusted him and he put me in a good situation. I didn’t panic or anything. I knew I was in good hands at this point.”

He later underwent surgery to relieve his symptoms, which took place a week after his diagnosis.

Stefanidis is one of thousands of Canadians diagnosed with brain and spinal cord cancer each year. according to the Canadian Cancer Society. The type he has, gliomas, is the second most common cancer among Canadians under the age of 40 and the second leading cause of cancer-related deaths in this age group.

And IDH mutant glioma usually develops in people in their 30s and 40s, when they are in the prime of their lives – working and raising families, explained Dr. Mary Jane Lim-Fat, a neurologist and neuro-oncologist at Sunnybrook Health Sciences Centre.

“There is currently no cure for diffuse gliomas in adults,” Lim-Fat told Global News. “So our best treatments until now, which have consisted of radiation and chemotherapy, only delay the time until the tumor grows back. It has been a big challenge to find better treatments for our patients.”

But there is hope. A new oral drug called Voranigo has been shown to target brain tumors Phase 3 clinical trialsto “significantly” slow their growth. Stefanidis participated in these clinical trials at Sunnybrook Health Sciences Center in Toronto, and he said the treatment was effective for his cancer.

“Since we received the treatment during the clinical trials… there have been no side effects from the medication, and on the plus side we have noticed stabilization and some shrinkage in the remaining [tumour]” he said.

And now it has been officially approved in Canada.

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On Tuesday, Health Canada announced the approval of Voranigo, the first targeted therapy for the treatment of grade 2 isocitrate dehydrogenase (IDH) mutant glioma in adults and pediatric patients aged 12 years and older, following surgery. It is Canada’s first oral targeted treatment for brain cancer.

Voranigo was studied in a large-scale, randomized, placebo-controlled clinical trial from January 2020 through February 2022 in patients from around the world, including Canada.

The results of the Phase 3 clinical trials were published in June 2023 in the New England Journal of Medicineand show promising results, Lim-Fat said.

“This new drug is essentially an oral drug that penetrates the brain and that patients can take by mouth. It changes the function of that mutant protein. By doing that, it slows the growth of the tumor, stabilizes it in some cases, and in some cases even reduces the growth or shrinks the tumor,” she said.

So what exactly does this mean?

Gliomas are difficult to treat and often progress to more aggressive forms of brain cancer, partly due to the blood-brain barrier. This protective layer protects the brain from damage, but also makes it challenging for therapies to penetrate and effectively target tumors, Lim-Fat explains.

Due to the blood-brain barrier, current treatment for gilomas involves a combination of surgery, followed by radiation and chemotherapy. Although these treatments can temporarily stop the growth of the tumor, Lim-Fat noted that it will eventually return.

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But Voranigo is specifically designed to cross the blood-brain barrier and reach the brain to target mutated enzymes that cause the cancer.

Results from Phase 3 clinical trials show that the drug more than doubled the time before tumors grew back in patients. It also delayed the need for interventions such as chemotherapy and radiation, which carry serious side effects.

“The median progression-free survival for patients who received a placebo – and therefore nothing – was approximately 11.1 months. But when they looked at the group that got [Voranigo]That progression-free survival, that delay was more than double that time, it was 27.7 months,” Lim-Fat said.

“These results alone are very encouraging and showed that this drug was actually quite good at slowing that progression in these patients.”

Now that Voranigo has been approved in Canada, Stefanidis said he hopes the drug can help others who are in the same situation.

After taking a leave of absence, he is now back to work as a firefighter and has even started traveling, exercising and hiking again.

“I feel like an ordinary, normal, healthy adult. I am slowly returning to my normal daily routine. I’m back to work now, fully back to responding fire trucks. And it feels great to work with the same team again,” he said.

“I recently had my first holiday in July this year. And it felt great just to go there. And that’s another thing about this drug. It’s not something where I had to stay within my environment because I could only get the treatment there. I can take this anywhere and use it as a mobile treatment,” he added.

Stefanidis said he takes it once every morning, similar to a multivitamin, and keeps track of it in his diary for dosage and time.

Lim-Fat said the oncology community is really excited about the drug’s approval in Canada, saying, “We haven’t had a breakthrough like this on a new drug in about 20 years.”

However, she noted that some questions remain. Doctors still don’t know what the long-term survival outcomes are for patients taking the drug, and whether certain groups of patients may respond better or longer to treatment.

“But nevertheless, we think it’s a major breakthrough and major progress in terms of providing more options for patients,” she said.