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PNA Spotlight: Dr. Michael Ivan

Dr. Michael IvanThis month’s PNA Spotlight focuses on Dr. Michael Ivan, Assistant Professor of Neurosurgery at the University of Miami and Director of Research at the University of Miami Brain Tumor Initiative. He also serves as Chief of Service in Cranial and Neuro-oncology and is Co-chair of Neurosurgery at Jackson South Community Hospital. Dr. Ivan did his undergraduate work in chemical engineering at Cornell, then got an M.B.S. in Biomedical Sciences and his M.D. from Rutgers University. He then moved on to the University of California, San Francisco for an internship in general surgery, a post-doctorate research fellowship in neuro-oncology, and a residency in neurosurgery. He also did fellowship in surgical neuro-oncology at the University of Miami. He was kind enough to answer some questions for the PNA. Here are his answers.

What inspired you to choose your career path?

I first developed my interest in the neurosciences during my undergraduate studies at Cornell University. The brain is often called the final frontier of medicine and the more I read about the brain the more I became excited about its complexity and the fact that there is so much yet to discover. It was also at this time that my passion for research was ignited. My research consisted of developing new drug delivery mechanisms using light-sensitive fluorescent labelers on biodegradable polymers. My desire to develop my own therapeutic agents grew and I decided to pursue a career in this area. After graduating from Cornell, I joined Merck & Co., Inc., where I spent 3 years improving human vaccines including the HPV, MMRV, and neuroma vaccine processing design. My passion in medicine continued to grow along with a desire to be closer to patients which led to leaving Merck for medical school. I was immediately drawn to neurosurgery, specifically academic neurosurgery. The idea of continuing my pursuit of novel therapeutic agents for brain tumors, translating this research to clinically applicable therapy, and performing highly technical surgery to resect tumors was a dream job. Once I met my mentor Dr. Andrew Parsa, I became dedicated to brain tumor research and completed postdoctoral fellowship at UCSF under his guidance. After residency, I continued my training with a clinical fellowship in surgical neuro-oncology. Currently, I act as a brain tumor and skull base neurosurgeon, brain tumor scientist, and Co-Director of Research of the University of Miami Brain Tumor Initiative in the Neurological Surgery Department at the University of Miami.

What is the primary focus of your work/research?

At University of Miami, I co-direct a large group of scientists and physicians in the University of Miami Brain Tumor Initiative, where we focus on improving the treatment of brain tumors through clinical, translational, and basic science efforts. My own laboratory focuses on the microenvironment of brain tumors, including pituitary tumors and their invasive qualities. We aim to use novel delivery methods such as oncolytic retroviruses to inhibit novel targets that were before thought to be unreachable in the brain due to the blood brain barrier. My clinical research, which is outlined in more than 60 publications, focuses on improving the treatment, outcome, and quality of life of patients with skull base tumors, such as pituitary tumors, with new minimally invasive and state-of-the-art methods, including laser interstitial thermal therapy, endoscopic and fluorescence-guided surgery. I have been fortunate to have my research supported by the Neurosurgery Research and Education Foundation (NREF), The Elsa U. Pardee Cancer Foundation, the American Cancer Society, and Sylvester Comprehensive Cancer Center. Seeing the benefit from the research we perform in the lab (on developing new therapies for tumors) and in the clinic (on patient outcomes), continues to ignite my passion for this field.

What do you consider to be the future of your field?

Currently, it is an exciting time for brain tumor and pituitary research. We now have the tools to understand each patient’s tumor and its unique biology through the use of comprehensive genomic characterization. Even more exciting, we are developing novel targeted drug and immunotherapies for each patient. Precision medicine is here and is available to every patient. As we continue to learn more about these therapies there will no doubt be improvement in their effectiveness and ability to combine each therapy for a synergistic approach. I believe that not only will the tumor pathology prove to be important but also preparedness and stimulation of each of our immune systems will allow us to treat tumors more effectively. With this knowledge, it is very likely that treating patients without surgical intervention can be made possible.

On a surgical side, we are continually improving our technology to allow less invasive, less risky and more successful surgeries by using a combination of improved preoperative imaging and navigation, better tumor visualization (with fluorescence and intraoperative microscopy) and improved technology such as laser interstitial thermal surgery.

What should patients know about your field/what deserves more recognition/awareness?

Pituitary tumors and brain tumors in general are a very complex disease that spans not only the brain but multiple organs. For pituitary lesions, especially, a multi-specialty team approach is an absolute necessity and all members involved should be dedicated and experienced in neuro-endocrine disorders. These specialists include neurosurgery, neuro-endocrinology, neuro-ophthalmology, ENT, Interventional Neuroradiology, Neuroradiology, and Stereotactic Radiosurgery/Radiation Oncology. For surgical patients the experience, sub-specialization, and volume of the neurosurgeon and the ENT (otolaryngologist) surgeons have been demonstrated to have an impact on patient outcomes. At the University of Miami, we have a very high volume and I work together with an incredible team of ENT colleagues multiple times each week. Each patient is also seen by a dedicated neuro-endocrinologist prior to leaving the hospital so that care can be initiated and then transferred to the patient’s home physicians in a well-orchestrated manner. Finally, all cases are reviewed by our multidisciplinary team both prior to surgical intervention and afterward. Many patients do not know that there are many clinical trials ongoing and available to them, especially for persistent tumors, to try to prevent further surgical intervention. We find that discussing these opportunities with patients both before and after surgery allows all options to be more thoroughly evaluated and for the best personalized plan for each patient to be implemented.

What would you like to convey about yourself to your patients?

My parents and mentors have always stressed that every patient should be treated like family. In doing so, I often end up in a partnership with each patient that can support them and provide them with the education on treatment strategies well past their surgical intervention.

A pituitary tumor diagnosis can be a life-changing and complicated time for any patient and their family. Often patients are seen by many physicians of different specialties. This can lead to many evaluations and opinions and synthesizing all of the information can be difficult. Communication with patients and all of their physicians is imperative. As a surgeon, I am here to help the patient make a well-informed decision after understanding all treatment possibilities and ensure they get the most up-to-date information on each treatment strategy. Access and thorough communication between patients and key providers are key so that any questions can be answered as soon as possible. All patient’s cases are discussed with our multidisciplinary team to develop a very personalized treatment plan. Obviously, we hope that most patients with these diseases are treated medically or with observation, but when that is not the best option our team works around the clock to make any patient’s surgical or radiosurgery experience as seamless as possible.

Why did you get involved with the PNA and what is the extent of your involvement?

PNA is an amazing resource for anyone with a pituitary disorder or tumor. I have come here to interact more with patients and colleagues who share a common goal in finding the best possible treatment for this disease. I treat a large number of pituitary tumors in Miami and therefore becoming more involved in PNA in any way possible will help my own patients as well as many others. I look forward to educating more of the community on this complex disease and share with them the new clinical and laboratory discoveries from my laboratory and clinical research. I encourage my own patients with pituitary disorders to use this resource to better understand the continuing treatment, support, and care of their disease.

 

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