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Neuro-oncology

Leading with a focus on the patient

Katie Metrock, M.D., manages one of the nation’s largest pediatric neuro-oncology programs at Children’s of Alabama.

According to data from the CDC, brain and spinal tumors are the leading cause of death among childhood cancer patients. Katie Metrock, M.D., director of the pediatric neuro-oncology program at Children’s of Alabama, says being diagnosed with one of these cancers is “one of the scariest things that can happen to a family.”

The program, which is part of the Alabama Center for Childhood Cancers and Blood Disorders at Children’s, is one of the largest in the U.S. It offers a focus on treating children and adolescents with brain and spinal cord tumors as well as neurofibromatosis, a genetic condition that predisposes children to tumors. It is a leading center for clinical studies and basic research into these conditions, and it offers a neuro-oncology fellowship. Metrock took over as director of the program in October 2023.

“It is my goal that every patient that comes through this door feels like they have a team of people that are fighting for them,” she said. “I don’t want any patient to ever feel like they’re alone or any family to feel like they needed more.”

For Metrock, the battle has a personal element to it. When she was young, her aunt developed a brain tumor, and Metrock remembers visiting her in the hospital. “I was very fascinated by all that was happening,” she said. Her aunt “did quite well,” she added, and the experience sparked her interest in the treatment of brain tumors. In college, that interest grew when she worked at a camp for children with cancer and met a young patient with a brain tumor.

“So when I went to medical school and residency, I tried to keep an open mind and looked at all the different types of fields,” Metrock said. “But I think ultimately I knew this is the space I wanted to be in—to help these children and to improve their treatment options.”

Now, that’s her daily goal. As the program’s director, she leads a team that includes four pediatric neuro-oncologists, three pediatric nurse practitioners, child life specialists, chaplains, social workers, neuropsychologists and researchers. They collaborate closely with neurosurgeons, neurologists, advanced/palliative care physicians and radiation oncologists to provide comprehensive care tailored to each patient’s needs.

“It takes all of us working together to help patients and their families through this entire process,” Metrock said. “Ever since coming here to Children’s, I have been blown away with the teamwork approach.”

The center’s mission extends to research, which is desperately needed, Metrock added. “We have to do better for these kids,” she said. “Making research at the forefront of our mission is huge.”

To that end, the program participates in several clinical trial research consortia, including the Children’s Oncology Group, the Pediatric Neuro-Oncology Consortium (PNOC), and the Sunshine Project. The partnerships allow Children’s to offer leading-edge clinical trials to patients while contributing to the broader advancement of the field.

For instance, researchers are investigating methods to deliver medications more effectively across the blood-brain barrier, which remains one of the greatest challenges to improving survival. They also are conducting clinical trials into less invasive, safer and more effective treatments for tumors like medulloblastoma, craniopharyngioma and germ-cell tumors. Additionally, they’re exploring vaccines to target high-grade gliomas.

The program is also expanding its educational reach globally. A new partnership with St. Jude Children’s Research Hospital aims to develop educational programs in neurofibromatosis for areas with limited expertise in treating neurofibromatosis-related tumors. The team also has a partnership with Washington University School of Medicine in St. Louis for a global neuro-oncology fellowship.

The primary focus, however, remains the child. “When a child comes in, the first thing we need to know is what type of tumor do they have and how do we treat it,” Metrock said. “But I think you can get tunnel vision with that. You really have to see that this is a child, and they have their whole life around them and then the life that they’re going to move forward with after this. So how do we meet them where they’re at and how do we help them move forward with the best success possible?” Those are the questions she aims to answer for each patient.

August 9, 2024 by childrensal

Big Changes Coming to Children’s of Alabama’s Neuro-Oncology Division

The Pediatric Neuro-Oncology Program at Children’s of Alabama will launch new initiatives this year, including forming a relationship with Children’s Cancer Hospital in Cairo, Egypt, pictured above.

Girish Dhall, M.D., can quickly tick off the attributes of Children’s of Alabama’s Pediatric Neuro-Oncology Program that lured him from Children’s Hospital Los Angeles to become division director for the Hematology, Oncology, and Blood and Marrow Transplantation Program as well head of the Neuro-Oncology program here. “It’s a very robust and academically active program in the country,” he said. “One of the strong points is that we have four neuro-oncologists, four pediatric neurosurgeons, two pediatric neuroradiologists and one pediatric neuropathologist. This is not available in most hospitals in the country.”

Indeed, the Pediatric Neuro-Oncology Program at Children’s of Alabama is one of the strongest in the country, treating between 50 and 70 newly diagnosed patients a year and participating in cutting-edge clinical trials for children with brain tumors.

In 2020, Dhall and his team will welcome their first neuro-oncology fellow. “So we will train the next generation of pediatric neuro-oncologists,” he said.

“There is such a need to have more people trained,” Dhall said. “Pediatric brain tumors are the most common cancer in children and we don’t have enough people trained to treat them.”

“Neuro-oncology is very specialized,” said pediatric neuro-oncologist Laura “Katie” Metrock, M.D., who will run the fellowship program. “The general hematology/oncology fellowship is more broad. This opportunity provides a full year of exposure to all aspects of neuro-oncology that are not available in the general fellowship.”

Metrock, who completed her own neuro-oncology fellowship at Emory University in Atlanta before coming to Children’s of Alabama, noted how much she appreciated her year of training. “I’m very excited to help others in that phase of their career,” she said. “If they choose to stay here then they will be helping kids in our community and if they go to other centers it provides more opportunity for collaboration.”

Metrock is also leading initiatives in neurofibromatosis (NF), which predisposes patients to nervous system tumors. “I took the position at Children’s of Alabama because I saw such a huge opportunity here,” she said. She is excited about working with the Neurofibromatosis Clinical Trials Consortium, which is based at the University of Alabama-Birmingham. The Consortium, directed by Bruce Korf, M.D., Ph.D., is a national leader in clinical and genetic studies on NF. “The ability to work directly in the front line of these trials coming through the Consortium was a huge opportunity,” Metrock said. “We have the opportunity to build something really special here for families and patients with NF.”

That includes a multidisciplinary clinic where children with NF-related cancers can obtain the variety of care they need from not only oncologists and hematologists, but geneticists, neurologists, endocrinologists and others. “We try to streamline their care and make sure they have access to other specialists, available therapies, and clinical trials,” Metrock said. That includes a partnership with the Pediatric Cancer Genetics Clinic. “We want to help the kids as they go through each phase and then ensure a smooth transition to the adult world,” Metrock said.

Among the other initiatives Dhall has begun is a global outreach in neuro-oncology. An oncologist from Vietnam recently trained in Alabama for two months and Dhall is now formalizing a relationship with the Children’s Cancer Hospital in Cairo, Egypt, which treats about 60 percent of the country’s entire pediatric cancer population. “We see about 150 pediatric cancer patients a year,” he said. “They see 4,000 a year. So the impact that we could have in helping train their doctors here is huge.”

January 16, 2020 by childrensal

Hematology and Oncology, Inside Pediatrics

Children’s of Alabama Ramps Up Pediatric Oncology Research Program

The faculty of the Pediatric Hematology, Oncology, and Blood and Marrow Transplantation program at Children’s of Alabama and the University of Alabama at Birmingham (UAB). The program is currently working to offer more potentially life-saving clinical trials to patients.

It’s only been a year since Girish Dhall, M.D., moved from Los Angeles, where he was an associate professor of pediatrics and director of the Neuro-Oncology Program at Children’s Hospital Los Angeles, to Birmingham to become division director for the Pediatric Hematology, Oncology, and Blood and Marrow Transplantation program at Children’s of Alabama and the University of Alabama at Birmingham (UAB). Yet he’s already made significant progress on one of his key goals: offering more potentially life-saving clinical trials to patients.

“We’re trying to increase our research portfolio through multiple mechanisms,” he said. Children’s already belongs to the largest pediatric cancer research organization in the world, the Children’s Oncology Group (COG), an international consortium of more than 200 children’s hospitals, universities, and cancer centers. Children’s of Alabama and UAB participate in the COG Phase I Consortium, the Neurofibromatosis Consortium and the Next Consortium, all of which conduct cutting-edge clinical trials for pediatric patients with nervous system tumors.

While COG is a major force in pediatric oncology, the number of trials it offers is limited. With about 150 new cancer patients a year seen at Children’s of Alabama, Dhall said, more opportunities are needed. “Even though we’ve come from a survival rate of zero 50 or 60 years ago to nearly 70 percent, 30 percent of patients still relapse,” he said.

Thus, Children’s of Alabama and UAB joined the Sunshine Project, which is a part of the National Pediatric Cancer Foundation. It emphasizes basic and translational research in the areas of bone and soft tissue sarcoma and brain tumor immunology, Dhall said. In addition, Children’s of Alabama and UAB are joining the ReMission Alliance Against Brain Tumors (RAABT), a University of Florida-led network of neuro-oncology, tumor immunology and genetics experts from top peer institutions as well as a community of vested collaborators and influencers affected by brain cancer.

To manage the expected growth in clinical trials, Dhall is also reorganizing the department’s clinical trial infrastructure to improve efficiency and recruiting additional staff to prepare for the anticipated increase. He also wants to add other scientists who can build on the department’s portfolio not just in brain tumors, but also in sickle cell disease and leukemia. “That’s my hope for the next year,” he said.

He predicts that the number of clinical trials, today at about 10, will double within the next two years.

“Patients who relapse after front-line therapy have a very poor prognosis with poor survival,” Dhall said. “So, for us to be able to offer treatment options here means they don’t have to travel to other sites like Atlanta or Memphis, which is a huge disruption for patients at the end of life.”

“As a physician,” he said, “this gives me hope and it keeps me going.”

January 16, 2020 by childrensal