Stacy Pfaller, PhD, has used her personal experience to advance the quality of care for future patients living with a glioblastoma multiforme diagnosis.
Stacy worked as a research microbiologist at the U.S. Environmental Protection Agency. She is the author of more than 30 published reports through the EPA’s National Exposure Research Laboratory.
Her battle began in the summer of 2018 with a breast cancer diagnosis. Stacy underwent a partial right mastectomy, chemotherapy, radiation therapy and a lumpectomy in January 2019.
Life delivered another blow shortly after, on Sept. 2, 2019, which happened to be both Labor Day and Stacy and her husband Jim’s wedding anniversary.
Stacy started to have difficulty finding words and was having seizures; subsequently, she was taken to the emergency room.
While in the emergency room, imaging revealed a large mass stretching across both the left and right sides of the frontal lobe. The biopsy came back as a WHO grade IV glioblastoma.
“It was so jarring; there is no curing of this cancer, only ways to control it. How could there be a second cancer? It didn’t make sense — Stacy was just getting over breast cancer and now we were being told she had anywhere from only eight to 22 months to live,” said Jim, Stacy’s husband.
The two cancers are completely unrelated; gliomas develop in the brain and remain there; the tumor doesn’t spread to any other areas of the body.
Gliomas are malignant brain tumors with unknown cell origin. Glioblastoma is the most aggressive and infiltrative category of these tumors. There is no cure; with optimal treatment, patients have an average survival of one year, according to the National Center for Biotechnology Information. There are, however, treatment options to target the infiltrative component of the glioblastoma and slow tumor progression.
Following diagnosis, glioblastoma patients typically undergo surgical resection, followed by radiation in conjunction with the chemotherapy medication temozolomide (TMZ).
Due to the size and location of the tumor, surgery wasn’t an option for Stacy, and she couldn’t tolerate the harsh side effects of TMZ. Her treatment plan required thinking outside of the usual standards of care.
“Stacy was not a candidate for any of our clinical trials because of her recent breast cancer history,” said Soma Sengupta, MD, PhD, UC Health neurologist and neuro-oncologist, associate director of clinical trials at the University of Cincinnati Brain Tumor Center and associate professor in the Department of Neurology & Rehabilitation Medicine at the UC College of Medicine.
Combination Therapy for Patients with Glioblastoma
Initially, Stacy received a standard-of-care therapy involving an anti-cancer chemotherapy medication in combination with radiation, but her bone marrow could not tolerate the chemotherapy.
Dr. Sengupta then tried Stacy on an old class of immunotherapy that blocks new blood vessel growth often used in treatment for glioblastoma. However, Dr. Sengupta combined this with a wearable, portable tumor treatment field device commonly used to slow or stop tumor growth in patients with recurrent glioblastoma.
Stacy needed an out-of-the-box strategy for her treatment, and Dr. Sengupta felt this combination therapy might work well for her.
Designed to prevent tumor growth, the anti-cancer immunotherapy medication starves the tumor by blocking a protein called vascular endothelial growth factor, or VEGF. Normal cells make VEGF, but some cancer cells make too much VEGF. Blocking VEGF may prevent the growth of new blood vessels, including normal blood vessels and blood vessels that feed tumors. Unlike chemotherapy that attacks the cancer cells, the purpose of this medication is to block the blood supply that feeds the tumor. This can stop the tumor from growing.
Indicated to treat glioblastoma in adult patients, the wearable, portable, FDA-approved device works by creating tumor treating fields, or TTFields, which are delivered right into the area of the tumor. When the device is turned on, it creates low-intensity, wave-like electric TTFields. Using four adhesive patches called transducer arrays, TTFields are delivered to the location of the tumor.
The device interferes with glioblastoma tumor cell division, slowing down or even stopping it. TTFields may cause tumor cells to be destroyed.
Stacy began the combination therapy in December 2019, just before Christmas.