In short, Black has a penchant for taking on challenging tasks that require meticulous planning and multiple skills--and succeeding. His approach to brain cancer is no different. He began training as a neurosurgeon for the stressful, delicate job of cutting into the living brain. But he also plunged with equal dedication into work in the laboratory, where he studied the basic biochemistry of tumors.

Black is best known for his discovery that bradykinin, a natural body peptide, is highly effective in opening the blood-brain barrier by making capillary walls leaky--the way leukotrienes do, he says, only to a greater degree. "The fantastic thing about bradykinin," says Black, "is that it does not open the barrier to the normal brain--only to tumors." By using RMP-7, a synthetic version of bradykinin, Black's team has been able to focus chemotherapy drugs right on the tumors, increasing the effective dose as much as 10-fold. Crucial to RMP-7's success, however, is the development of more effective chemotherapy drugs against brain cancer.

Black is also working on an entirely different experiment for treating tumors. Cooperating with molecular biologist Habib Fakhrai, he is trying to enlist the patient's own immune system to attack brain cancers. Tumor cells produce a substance called TGF-beta (transforming growth factor-beta) that both fuels their own growth and tricks the immune system into ignoring their presence. Using genetic engineering, Fakhrai has come up with a genetic "switch," called TGF-beta antisense. When inserted into a tumor cell's genetic machinery, the antisense turns off the cell's ability to produce TGF-beta. Injected into patients, these deactivated cells work like a vaccine by becoming immediate targets of the immune system, which simultaneously kills off other tumor cells circulating in the body. In a current clinical trial, one patient's cancer has been arrested, with four more treatments to go. Twelve more patients are being selected for an upcoming trial.

Black now wants to turbocharge TGF-beta gene therapy with dendritic cells, white blood cells that identify foreign proteins for destruction. He proposes to harvest dendritic cells from a patient's blood, expose them to cancer proteins in a test tube and reinject them. The cells would then point out the now familiar proteins to the immune system's killer T cells, which would track them down like bloodhounds that have been exposed to an escaped convict's dirty laundry. "We can completely eradicate glioblastomas in rats using this strategy," says Black. "We want to get these treatments out into clinical practices as fast as we can."

The reason for such urgency is that no matter how carefully a surgeon cuts out a malignant tumor, the few stray cancer cells that are inevitably left behind will begin to grow again. TGF-beta and dendritic cells, or any one of a dozen other treatments under investigation by Black and others, could lead to the true cure for brain cancer that is Black's long-term goal.

Meanwhile, as new treatments go through the painstaking testing and approval process, Black is determined to do his absolute best with the tools at hand, using creative surgical techniques to get at cancers once considered all but intractable. For example, clival chordomas, deadly tumors that grow at the base of the skull, could be reached only by cutting through the entire brain, which left patients devastated. As one of the pioneers of skull-base surgery, Black now removes clival chordomas by going up through the nasal passage, bypassing the brain entirely. His patients go home without any loss of function (known to doctors as a "deficit").

Surgically, Black is as aggressive as his foe but also excruciatingly careful. During his residency, Black recalls, "we would get postoperative scans, and you could actually see the physical damage where the neurosurgeon had used instruments to pull the brain back to expose the tumor. I never touch the brain. It's sacred. It's a concept I try to teach the residents. The whole goal is to extract the tumor without disturbing the normal brain. It's as if the brain is asleep and you want to sneak in and remove the tumor and never wake the brain up."