How Brain Cancer Treatment Is Changing: Q&A with Dr. Markus Bredel
Radiation oncologist and physician-scientist Markus Bredel, M.D., discusses advances in brain cancer treatment, glioblastoma research and efforts to bring specialized care closer to patients.
Ten years ago, Markus Bredel, M.D., would have said the life expectancy for a patient with stage IV brain metastatic cancer was three to six months. That’s changed dramatically, with new treatments including better radiosurgery techniques.
“I have patients who I have been following for seven, eight years, where the situation was acutely life-threatening, and now we’re transforming this more into a chronic condition. That makes me very proud,” said Dr. Bredel, chairman and professor of radiation oncology at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.
Dr. Bredel shares about his research and clinical work in the following interview, which has been edited for length and clarity.
Tell us about your work at Sylvester.
As chairman of the department of radiation oncology, I lead a high-technology department with about 60 faculty members. We’re always moving fast, so there’s need for innovation.
I am a clinician, treating patients with primary brain tumors and secondary brain cancer from systemic cancer. I am maybe atypically busy for a chairman. Yesterday in clinic I saw 40 patients. But those patients are in dire need, so that is close to my heart.
Educating residents is at the core of our department, because we’re building the next leaders in the discipline. They need to be proficient in the technology we have, but also have the skills to become great clinicians.
Finally, I’m an NIH R01-funded physician-scientist. My lab focuses on brain tumors, particularly glioblastoma, which is the most aggressive and common form.
What led you to become a physician-scientist and to focus on radiation oncology?
My uncles and granddad were surgeons, so I wanted to be a surgeon as well. I always loved neurosurgery, so after medical school I trained in Germany, where I was born and raised. I went to Stanford as a postdoc in the division of oncology, focused on developing a brain tumor research program. I was recruited to a faculty position at Stanford, then to Northwestern.
I loved brain radiosurgery, the part that is closed and non-invasive. With evolving technologies, my mentor at Stanford told me I would be better educated as a radiation oncologist than a neurosurgeon. I trained at the University of Alabama-Birmingham, functioning as a resident and an associate professor with my own laboratory. I was involved with a UAB group in developing a brain radiosurgery technique that allows us to treat almost an endless number of brain metastases at the same time. Last week I treated a case with 95 brain metastases and the procedure took just 15 or 20 minutes.
When I received the offer from UM, everything was spectacular: the institution, the technology, the size of the department, the bandwidth, the reputation, the living space. My family wanted to go to a more cosmopolitan, vibrant environment, so Miami checked all the boxes.
You’ve said it’s “a time of great promise” for brain cancer treatment. What is some promising research you’re working on?
We are looking at genetic networks and genes that impact brain cancer, especially glioblastoma and so-called gliomas. We found a tumor suppressor gene that goes back to my time at Stanford, but now we have compelling data that it functions in a very different way than we thought. The status of that gene predicts the patient’s outcome. If the gene is lost, the outcome is bad. If the gene is intact, patients do better. It outperforms anything in terms of pathological, clinical and molecular markers. We’re moving this slowly into patient prediction, working on an assay to pick up genetic alterations with a blood draw instead of a biopsy.
We now have small molecular inhibitors that target the alteration. We’ve seen phenomenal responses in the lab. The hope is that at some point, this will translate to the bedside.
How have you worked to bring radiation oncology treatment closer to patients?
Our philosophy is of going into the community rather than the patients having to come to us. We have access to technology at UM that few centers in the nation have, which is more effective and minimizes side effects. What we realize is that patients traveling long distances comes with financial toxicity. That’s why we’re building all these satellites, like SoLé Mia, Plantation, Doral. I’m happy to report that I recently got board approval to build a second proton beam therapy center at Coconut Creek.
What is a fun fact about your life outside work?
My fun fact is my four little monsters! My wife and I always had a dream for a larger family, and having four children with all that I have going on is something we’re proud of. I’ve been very involved. I always say I changed at least 20,000 diapers, but it’s certainly my wife who deserves more of the credit. We have two children at UM. Two are at home, and they also want to go to UM. The whole Bredel tribe is here, and that’s how we love it.
More from the Miller School of Medicine
University of Miami researchers report that biomarkers and MRI show similar performance in predicting prostate cancer risk.
Researchers at Sylvester map how IDH-mutant gliomas evolve after treatment, revealing why tumors recur and pointing to precision cancer care.
As she graduates from the Miller School of Medicine, Kaylie Cullison, M.D./Ph.D, applies imaging science to personalize brain cancer care.
Sylvester physicians use adaptive radiation therapy and daily imaging to adjust cancer treatment in real time.
Tags: brain cancer, cancer research, Department of Radiation Oncology, genetics, glioblastomas, gliomas, Radiation oncology, Sylvester Comprehensive Cancer Center