Dr. Marc Siegel: John McCain may be in the fight of his life but don't count him out

Senator John McCain, the maverick, the “warrior at dusk,” as his daughter Meghan McCain calls him, is in the fight of his life.

“The cruelest enemy could not break him,” she wrote yesterday. “The aggressions of political life could not bend him. So he is meeting this challenge as he has every other. Cancer may afflict him in many ways: But it will not make him surrender.”

McCain’s courage and his dogged determination to never give up will help him in his fight against the cruelest enemy of all: I haven’t examined him or reviewed his records this time as I did in 2008 but if it is correct that he has an aggressive stage IV glioblastoma, he is faced with a poor prognosis.

This type of cancer that is built of the supporting cells of the brain and infiltrates brain tissue, making it extremely difficult to remove it entirely. This type of cancer afflicts approximately 12,000 patients a year, and the life span following diagnosis is usually 12 to 14 months.

Though a small percentage of patients live for five years or more, older patients — McCain is 80 — tend to fare worse. The standard treatment — radiation and chemotherapy — is generally not very effective, because the cancer spreads its tentacles into surrounding brain tissue, where nothing can stop it.

There is some hope on the neuroimaging front. Last year, during a visit with Fox News to Henry Ford Hospital in Detroit, I interviewed its chief of neurosurgery, Dr. Steven Kalkanis, about “bright matter software” — a color-coded imaging technique he and others were utilizing as part of MRI scanning to guide brain surgery and remove tumors that are not apparent in regular imaging.

In terms of treatment, some attempts at immunotherapy and creating vaccines that will target the cancer have focused on the Epidermal Growth Factor Receptor mutation, which is present in 30 percent of glioblastoma patients. These treatments have had limited success, but researchers at the University of Pennsylvania’s Perelman School of Medicine, in a study just published in Science Translational Medicine, had more promising results when they combined them with state-of-the-art chimeric antigenic receptor (CAR) therapy, where a patient’s killer T cells (immune cells) are taken out of the body and reprogrammed genetically to fight this particular cancer mutation.

The variability of the cancer proteins as well as the cancer’s ability to fight back and limit the effect (immunosuppression) still need to be overcome, but these are steps in the right direction in the war on cancer, with much more to come.

Former Vice President Joe Biden, whose son Beau and longtime friend Senator Ted Kennedy both died of glioblastoma, has been a huge advocate in this fight. With Biden’s urging, Congress passed and President Obama signed the $6.3 billion 21st Century Cures Act last December. The act provides $4.8 billion to the National Institutes of Health for research over 10 years, including $1.8 billion for cancer prevention, treatment and research.

McCain has beaten the odds before. He has survived several bouts of skin cancer, including a melanoma in the same part of the brain in 2000.

As a POW in Vietnam, he famously refused early release and endured more torture so that other soldiers who had been there longer than he had been could be freed.

We hope and pray that the selflessness and sacrifice he displayed then will be repaid with a medical miracle now.

Could his experience in Vietnam have increased his cancer risk? Most studies have not demonstrated a link between Vietnam service and exposure to the herbicide used by the U.S. military in battle, Agent Orange.

John McCain survived Vietnam and went on to a long and distinguished career as a statesman and leader.

Despite the terrible odds against him, my experience as a physician tells me not to count John McCain out.