September 29, 2023

Developing a less invasive way to diagnose and better manage treatment for kids with brain cancer

September is Childhood Cancer Awareness Month

(photo: WCHRI)

Brain cancer diagnosis and monitoring can be risky procedures that require delicate surgery to collect tumour samples. The procedures can be even more difficult when the tumour is deep in the brain. Pediatric neuro-oncologist Liana Nobre, a recent recruit to the University of Alberta, is researching a less invasive approach called “liquid biopsy” to not only provide a lower-risk diagnostic test but to enable better monitoring afterward and more personalized medicines to treat children, adolescents and young adults with brain tumours.

Brain and spinal cord tumours are the second-most commonly diagnosed cancer in children in Canada and the leading cause of childhood cancer death. Glioblastoma is a type of brain cancer that claimed the life of Ben Stelter, a charismatic six-year-old who became an inspiration to the Edmonton Oilers NHL hockey team throughout his illness and captured the heart of the whole city.

Glioblastoma, and other gliomas, are a particular focus for Nobre, who trained as a pediatrician and pediatric neuro-oncologist in Brazil and worked as an oncologist consultant at the national cancer institute there. She eventually transitioned to a position at a pharmaceutical company as a medical manager investigating new cancer treatments. “My goal was always to be on the other side of research from an investigator perspective,” she explains of her decision to leave the company and pursue graduate studies to learn more. 

Even so, she still missed working directly with patients and a clinical fellowship in neuro-oncology brought her to Canada. Doctorate studies followed, to hone her research skills further, and she now has the opportunity to bring her knowledge and experience to continue both clinical care and research in Edmonton as an assistant professor in the Department of Pediatrics at the University of Alberta and member of the Women and Children’s Health Research Institute.

To improve outcomes and quality of life for children with brain cancer, Nobre approaches her work in two pillars of research. “One pillar is studying the specific tumours, and the molecular characteristics that they have, to detect new biological markers that allow us to develop new therapeutic strategies and predict response to these therapies,” she says. The other pillar, a big part of her research, looks at minimally invasive diagnostic tools like liquid biopsy.

We can remove the risk that surgery presents to patients by using liquid biopsies instead, she explains, taking advantage of the discovery that fluids like blood and cerebral spinal fluid carry small amounts of tumour DNA. The liquid biopsy is obtained much more easily than surgery, through a lumbar puncture with a needle inserted between two vertebrae and the sample is tested with an assay, a measurement developed for specific biological markers of the disease. While this technology has been developed for many adult cancers, there is a lack of testing specific to pediatric, adolescent and young adult cancers. 

“My work at the University of Alberta will leverage my previous experience in developing a liquid biopsy test to expand this tool to more patients with childhood brain cancers,” says Nobre. The liquid biopsy will detect changes in cerebrospinal fluid to assist with diagnosis, guide therapy decisions to tailor specific treatments to individual patients and more easily monitor patients throughout their treatment journey.

Nobre’s research has been funded by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute, thanks to a generous gift from the Ben Stelter Foundation.

“I’m truly grateful for this opportunity. And it’s really an honour to be able to receive this funding and develop a neuro-oncology research program that will focus on improving treatment for patients with pediatric gliomas and the devastating disease that Ben had,” says Nobre.

“It’s a great responsibility that I take very seriously, and a huge opportunity and honour to be able to kickstart the program this way.”