Henry Seth Friedman, MD

Professor of Neurosurgery
James B. Powell, Jr. Professor of Pediatric Oncology, in the School of Medicine
Assistant Professor of Pathology
Associate Professor of Medicine
Professor of Pediatrics
Member of the Duke Cancer Institute
Campus mail 047 Baker House, Durham, NC 27710
Phone (919) 684-5301
Email address henry.friedman@duke.edu

Overview: Our laboratory is pursuing a comprehensive analysis of the biology and therapy of adult and childhood central nervous system malignancies, particularly high-grade medulloblastoma, glioma, and ependymoma.

Laboratory Studies: Active programs, using human adult and pediatric CNS tumor continuous cell lines, transplantable xenografts growing subcutaneously and intracranially in athymic nude mice and rats, and as well as in the subarachnoid space of the athymic nude rats, and patients tumor specimens, are defining:

1) the chemotherapeutic profile of medulloblastoma, adult and childhood glioma and ependymoma
2) mechanisms of resistance to classical bifunctional alkylators, nitrosoureas and methylators operational in malignant glioma and medulloblastoma, particularly DNA adduct and crosslink repair, O6-alkylguanine-DNA alkyltransferase elevation and DNA mismatch repair deficiency.
3) modulations designed to over come or circumvent specific mechanisms of resistance
4) the activity of signal pathway inhibitors of EGFR, m-tor and other targets
5) the therapeutic advantages of intrathecal and intratumoral drug delivery in the treatment of neoplastic meningitis and intracranial malignancies, respectively.

The results of the therapeutic studies to date have demonstrated the marked activity of alkylating agents, particularly melphalan and cyclophosphamide and the role of glutathione, AGT glutathione-S-transferase, abnormal drug transport and alterations in formation and repair of DNA-DNA crosslinks in modulating cytotoxicity of these agents. Modulations shown to be effective in enhancing alkylator activity/reversing alkylator resistance include BSO-mediated glutathione depletion, inhibition of DNA-DNA crosslink repair and inhibition of 06-alkylguanine-DNA alkyltransferase by 06-benzylguanine. Recent studies have demonstrated profound activity of temozolomide, CPT-11 topotecan, irofulven, and karenitecin as well as the combination of CPT-11 or topotecan plus BCNU or temozolomide. Successful treatment of neoplastic meningitis in nude rats with intrathecal 4-hydroperoxycyclophosphamide, melphalan, temozolomide and busulfan, and intracranial glioma in nude rats with intratumoral temozolomide has also been demonstrated. More recent studies have revealed cyclophosphamide resistance secondary to DNA interstrand crosslink repair. Additional studies have shown that cyclophosphamide crosslinks are formed at the 1,3 N7 position, serving as the basis for construction of a defined crosslink in a plasmid vector to assay for crosslink repair and allowing demonstration of the lack of a role of nucleotide excision repair. Mismatch repair deficiency has been shown as a mechanism mediating acquired methylator (procarbazine and temozolomide) resistance in an adult glioblastoma xenograft.

Clinical Studies: Clinical investigations are designed to translate laboratory programs into successful treatment for adults and children with malignant brain tumors, particularly medulloblastoma. Clinical trials for adults include phase II trials of temozolomide, ZD1839 (Iressa), karenitecin, and temozolomide plus O6-BG as well as phase I trials of topotecan plus BCNU, CPT-11 plus temozolomide, and PTK787 ± temozolomide or CCNU. Studies are in progress in children evaluating the activity CPT-11 plus temozolomide, intrathecal busulfan and cyclophosphamide/melphalan or cyclophosphamide/busulfan plus autologous bone marrow support . Extension of these studies to a larger cohort of patients is being performed nationally under the auspices of the Pediatric Brain Tumor Consortium (Henry S. Friedman -- Head of New Agents Committee).

Future studies will address the role of agents designed to decrease repair of interstrand crosslinks when given in combination with alkylating agents, as well as newer signal pathway inhibitors such as RAD001, PKI166, and DB-67.

Education and Training

  • M.D., SUNY Upstate Medical University, 1977


Ghiaseddin, A, Reardon, D, Massey, W, Mannerino, A, Lipp, ES, Herndon, JE, McSherry, F, Desjardins, A, Randazzo, D, Friedman, HS, and Peters, KB. "Phase II Study of Bevacizumab and Vorinostat for Patients with Recurrent World Health Organization Grade 4 Malignant Glioma." The oncologist (November 13, 2017).

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Reap, E, Suryadevara, CM, Batich, KA, Sanchez-Perez, L, Archer, GE, Schmittling, RJ, Norberg, PK, Herndon, JE, Healy, P, Congdon, KL, Gedeon, PC, Campbell, OC, Swartz, AM, Riccione, KA, Yi, JS, Hossain-Ibrahim, MK, Saraswathula, A, Nair, SK, Dunn-Pirio, AM, Broome, TM, Weinhold, KJ, Desjardins, A, Vlahovic, G, Mclendon, R, Friedman, AH, Friedman, HS, Bigner, DD, Fecci, PE, Mitchell, DA, and Sampson, JH. "Dendritic cells enhance polyfunctionality of adoptively transferred T cells which target cytomegalovirus in glioblastoma." Cancer research (November 2017).

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Randazzo, DM, McSherry, F, Herndon, JE, Affronti, ML, Lipp, ES, Flahiff, C, Miller, E, Woodring, S, Freeman, M, Healy, P, Minchew, J, Boulton, S, Desjardins, A, Vlahovic, G, Friedman, HS, Keir, S, and Peters, KB. "A cross sectional analysis from a single institution's experience of psychosocial distress and health-related quality of life in the primary brain tumor population." Journal of neuro-oncology 134, no. 2 (September 2017): 363-369.

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Esbenshade, AJ, Kocak, M, Hershon, L, Rousseau, P, Decarie, J-C, Shaw, S, Burger, P, Friedman, HS, Gajjar, A, and Moghrabi, A. "A Phase II feasibility study of oral etoposide given concurrently with radiotherapy followed by dose intensive adjuvant chemotherapy for children with newly diagnosed high-risk medulloblastoma (protocol POG 9631): A report from the Children's Oncology Group." Pediatric blood & cancer 64, no. 6 (June 2017).

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Desjardins, A, Sampson, JH, Vlahovic, G, Peters, KB, Randazzo, D, Threatt, S, Herndon, JE, Bullock, CA, Miller, ES, Boulton, S, Lally-Goss, D, McSherry, F, Lipp, ES, Friedman, AH, Friedman, HS, Bigner, DD, and Gromeier, M. "Dose finding study of the intratumoral administration of the oncolytic polio/rhinovirus recombinant (PVSRIPO) against WHO grade IV malignant glioma (MG)." May 20, 2017.

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Batich, KA, Reap, EA, Archer, GE, Sanchez-Perez, L, Nair, SK, Schmittling, RJ, Norberg, P, Xie, W, Herndon, JE, Healy, P, McLendon, RE, Friedman, AH, Friedman, HS, Bigner, D, Vlahovic, G, Mitchell, DA, and Sampson, JH. "Long-term Survival in Glioblastoma with Cytomegalovirus pp65-Targeted Vaccination." Clinical cancer research : an official journal of the American Association for Cancer Research 23, no. 8 (April 2017): 1898-1909.

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Affronti, ML, Woodring, S, Peters, KB, Herndon, JE, McSherry, F, Healy, PN, Desjardins, A, Vredenburgh, JJ, and Friedman, HS. "A Phase II single-arm trial of palonosetron for the prevention of acute and delayed chemotherapy-induced nausea and vomiting in malignant glioma patients receiving multidose irinotecan in combination with bevacizumab." Therapeutics and Clinical Risk Management 13 (January 2017): 33-40.

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Kent, CL, Mowery, YM, Wright, AO, Kim, GJ, Desjardins, A, Peters, KB, Vlahovic, G, Friedman, HS, Cummings, TJ, McLendon, RE, Friedman, AH, Sampson, JH, and Kirkpatrick, JP. "Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis." October 1, 2016.

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Randazzo, D, and Peters, KB. "Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients." October 2016.

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Kent, CL, Mowery, YM, Wright, AO, Kim, GJ, Desjardins, A, Peters, KB, Vlahovic, G, Friedman, HS, Cummings, TJ, McLendon, RE, Friedman, AH, Sampson, JH, and Kirkpatrick, JP. "Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis." International journal of radiation oncology, biology, physics 96, no. 2S (October 2016): E83-E84.

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