Lynn Oxenberg leans over her toilet drop every two days as her husband trims her head’s brown hair.
She uses electrodes to apply extreme cancer cells to her head four yellow patches after being clean shaven to prevent them from growing in her brain.
She stuffs the jutting wires and a two-pound device into a small suitcase, then heads to the food store, or collection, or meal with friends.
This has been Oxenberg’s program for six decades. It can be exhausting, but it’s kept the 73-year-old Elkins Park, Pennsylvania, mother dead much longer than most people diagnosed with , glioblastoma, an aggressive brain tumor that kills in an average of 15 weeks.
The treatment regimen, combined with highly sensitive MRI tracking, is currently being investigated by Penn doctors to determine whether Lynn’s years of glioblastoma may become less of an aberration.
There is no solution for glioblastoma, and the condition is extremely difficult to treat. Glioblastoma is usually treated with a combination of surgery, radiation, and treatment, then monitored closely for evidence the tumor is growing afterwards. When the tumor begins to sprout, it is almost always dangerous. Surgery, chemotherapy, and radiation may never eliminate all of the tumor because glioblastoma cancers burrow into mental cell like an octopus ‘ tentacles.
Researchers at Penn are testing whether combining the tumor treating field ( TTF ) therapy Oxenberg uses with artificial intelligence-powered MRIs that measure a tumor’s “temperature” for highly precise results can help glioblastoma patients who have already undergone surgery and other treatments to reduce the size of their tumor to live longer.
The mix goes against the recommended course of treatment for the illness. TTF treatment, developed by Swiss pharmaceutical Novocure, sends energy fields through the head frequently to prevent cancer cells from growing, instead of waiting for the disorder to gain and administering it with more chemotherapy or radiation. The temperature-taking MRIs may show the earliest signs that a cyst is returning, and assist doctors quickly pivot their treatment program.
Suyash Mohan, Penn’s director of medicine study, calls it a “whole mind” treatment that could be more successful than attempting to remove a tumor that can never be completely eliminated. The TTF therapy keeps cancer cells in check, and the highly detailed MRIs can help  , make quick changes to treatment, if necessary.
Novocure’s FDA-approved TTF therapy device,  , Optune, has shown modest results in extending life spans for glioblastoma patients. Patients in Novocure’s phase 3 trial who wore the device 70-80 % of the time lived an average of 21 months, compared to 15 months among patients who received standard treatment. However, the device can be cumbersome: Patients must shave their heads to secure electrodes. Optune only works when it is worn, unlike medications that are left in the body for hours or days after taking them.
Some cancer experts contend that it can be difficult to persuade patients to take such aggressive measures despite the promising outcomes. The treatment is covered by Medicare and many commercial health plans, but costs$ 21, 000 a month without insurance.
It’s not known whether the treatment will ever significantly alter glioblastoma patients ‘ outlook. However, Mohan believes that the work at Penn offers a chance to treat one of the most notoriously aggressive cancers as a chronic condition.
” The overall survival of this disease has n’t changed in the last 25 years”, Mohan said. ” We have to reevaluate how we go about treating this tumor.”
Artificial intelligence-powered MRIs for glioblastoma
Glioblastoma , is a fast-growing brain cancer most common among older adults. Treatment can slow the cancer’s growth and help manage symptoms, but there is no cure.
Although some tumors are too deep in the brain, some patients may undergo surgery to remove the majority of the tumor. The tumor’s tentacles, which extend deep into the brain’s folds, are typically impossible to safely remove from the brain.
Although doctors may advise using radiation or chemotherapy to kill any remaining cancer cells, it’s difficult to kill cancer cells without also killing healthy brain cells because the tumor becomes so complex in the brain.
MRI imaging is used by doctors to determine whether treatments are shrinking the tumor. However, some medications result in inflammation that looks like a tumor on an MRI, making it difficult for doctors to identify the tumor’s exact location.
Mohan and his colleagues created a thermometer-like device that uses artificial intelligence to provide a more nuanced view of the brain. The MRI technique uses images from the entire brain to produce a real-time “temperature” that can reveal more precisely to doctors where a tumor is and whether it is growing or shrinking.
Every two months, patients are scanned twice as frequently as they would a conventional MRI. However, the outcomes are readily available, which can lessen the anxiety caused by waiting for answers and allow doctors to make more drastic adjustments to patients ‘ treatment plans, according to Mohan.
More sophisticated MRI images will be made to enable doctors to make more accurate, faster decisions regarding patient care, he said.
Disrupting glioblastoma cells with electricity
In a clinical trial with TTF-treated glioblastoma patients, Penn is currently testing the MRI technique. TTF sends electrical currents through the entire brain to stop cancer cell growth, while chemotherapy and radiation target specific tumor areas with varying precision.
Initial clinical trials for Optune revealed a modest increase in life expectancy for patients receiving TTF therapy and a higher chance of surviving for up to five years.
However, Stephanie Weiss, head of the division of neurologic oncology at Fox Chase Cancer Center, said the demands of the treatment outweigh the potential benefits for some patients.
Patients are required to shave their heads every two days to prevent the electrode pads from sticking to their skin, and they must also use an irritable glue.
Patients are supposed to wear the device for at least 18 hours per day for two years because the treatment only works when it is used.
” It makes a lot of sense”, Weiss said,” but I think what we’re doing right now is rudimentary”.
Novocure’s executive chairman, William Doyle, agrees there’s room for improvement. The business, which has locations in Wayne, is developing thinner head patches and looking into whether they can increase the power delivered through them, which would shorten the amount of time patients have to wear the device.
Additionally, the company is developing an app that will allow users to track how long they’ve been using the device.
Although Optune’s gauze head wrap and mini backpack may not be the most fashionable, they may make it possible for glioblastoma patients to live long enough to reach significant family milestones, such as a child’s graduation or wedding, Doyle said.
” You can live with this”, is the message the company sends patients and doctors, Doyle said.
Living with glioblastoma
Oxenberg was diagnosed in December 2017, and her doctor suggested she try Optune after she underwent surgery and as much chemotherapy as her body could tolerate. Oxenberg agreed.
She started receiving medication in April 2018 and spends 90 % of her days using the device.
Since the maternity ward nurses had paraded her around to show off the fiery fluff sticking out of the hospital’s swaddling blanket, she was reluctant to part with the red hair that had previously been her identity.
” I realized my hair was overrated”, she said.
It’s a trade she says she is willing to make for more time with her husband, children, and grandchildren.
Earlier this month, all 10 of them headed to North Carolina’s Outer Banks for their annual summer vacation. Her exposed scalp was affected by the sun and the sea breeze. She soaked it in.
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