Edward (Ed) Waldner had no idea why he didn't feel well, but he knew he didn't feel like himself. At 55 years of age, he felt exhausted all the time. It didn't seem to matter how hard he had worked that day. He wondered if he had sleep apnea. He noticed his walking was off. His heels would drag now and again. One day, when his symptoms were worse than usual, he decided to go to the Emergency department.
From left: Edward (Ed) Waldner, Gloria Roldan Urgoiti, Wee Yong. Photo Credit: Riley Brandt, University of Calgary
"The doctor said I had a mass on my brain and needed to see an oncologist," says Waldner.
The mass was glioblastoma, a deadly brain cancer. Treatment often involves a three-pronged approach: surgery to remove as much of the tumour as possible, followed by radiation and chemotherapy. However, despite advances in cancer treatment, the aggressive cancer comes back.
University of Calgary researchers are investigating whether adding high doses of vitamin B3 or niacin to the treatment plan could be beneficial. They approached Waldner about being in the trial.
The clustering of cancer cells in glioblastoma without treatment, left, and how the niacin stops cells from clustering. Photo Credit: Courtesy Yong lab
"I have no problem trying to help anybody. I agreed. I want to help myself, too," says Waldner. "I can tell you being part of this research helps me mentally because we're trying. When I left the hospital after surgery I was told, that's it, that's all we can do."
Hotchkiss, Charbonneau members partner for study
The research is led by two members of both the Hotchkiss Brain Institute and Arnie Charbonneau Cancer Institute Dr. Gloria Roldan Urgoiti, MD, PGME'16, an oncologist specialized in brain cancers, and Dr. Wee Yong, PhD, a neuroscientist whose research focuses on immune effects on the brain. Together, they designed a study to investigate whether niacin could rejuvenate compromised immune cells to kill tumour cells. The research began in the Yong lab, with mice, where findings showed niacin prolonged survival. That work evolved into a Phase I and II clinical trial.
A mouse brain before, left, and 42 days after niacin treatment, illustrating the slowing of the tumour. Photo Credit: Courtesy Yong lab
"Normally, the immune system will try to counter and prevent tumour growth; however, this brain cancer supresses the immune system," says Yong, a professor at the Cumming School of Medicine (CSM). "Niacin treatment rejuvenates immune cells so they can do what they are supposed to do, attack and kill the cancer cells. I see it as an ongoing battle for the brain.'"
Studying the benefits of adding niacin to chemotherapy, radiation
The clinical trial was designed to determine the maximum dose and potential benefit of controlled-release niacin that could be added to the recommended chemotherapy and radiotherapy treatments. Researchers decided the study would stop if the progression-free survival over six-months did not improve by at least 20 per cent compared with older studies. Early results involving 24 patients showed 82 per cent of the participants were free of progression of the cancer at six months; an increase of 28 per cent from previous studies. The researchers say this is a promising advancement for this incurable cancer.
"Glioblastoma is the most aggressive brain cancer in adults. Survival of patients with this condition hasn't changed significantly for 20 years," says Roldan Urgoiti, a clinical associate professor at the CSM. "Anything that may help should be explored, but it requires strict protocols and safety monitoring."
Wee Yong. Photo Credit: Riley Brandt, University of Calgary
The findings were published in the Journal of Neuro-Oncology.
The researchers caution that high amounts of vitamins, like niacin, have toxicity and can have a negative impact on someone's health if not monitored closely by medical professionals.
The team hopes to be able to do the final analysis, that will include 48 participants by the end of 2026 or early 2027.
Waldner says he's feeling really good these days and is just happy to hear the word "stable" when he goes for his regular scans.
The research is supported by the Canadian Institutes of Health Research and the Alberta Cancer Foundation.
Gloria Roldan Urgoiti is a clinical associate professor in the Department of Oncology at the Cumming School of Medicine and a member of the Riddell Centre for Cancer Immunotherapy, the Arnie Charbonneau Cancer Institute and the Hotchkiss Brain Institute.
Wee Yong is a professor in the departments of Clinical Neurosciences and Oncology at the CSM and alsoa member of the Arnie Charbonneau Cancer Institute and the Hotchkiss Brain Institute. He holds the Canada Research Chair in Neuroimmunology.
