Nadya El-Afandi, who was diligently nearing the conclusion of her arduous breast cancer treatment, received devastating news that would change her life forever: doctors had identified her with glioblastoma, a notoriously aggressive and rapidly growing brain tumor that considerably complicates treatment options.
Generally, individuals diagnosed with glioblastoma have a grim prognosis, with a life expectancy ranging between 12 to 18 months, even with the most aggressive treatment regimes. Notably, patients over the age of 60 face an even harsher reality, often succumbing within six to nine months. At the time of her diagnosis in June 2023, El-Afandi was just 59 years old, placing her precariously within that unfavorable demographic.
“While I was still undergoing chemotherapy, my breast cancer doctor delivered a sobering message: ‘You don’t need to continue that treatment any longer, nor will you require further breast exams,'” El-Afandi recounted. “Without explicitly saying it, the implication was clear—’The glioblastoma will likely take precedence over the breast cancer.'”
In a significant breakthrough in treatment, two innovative trials are underway, both spearheaded by experienced doctors at the prestigious Mayo Clinic. One trial recently concluded its second phase, revealing that the integration of advanced imaging alongside a targeted form of radiation therapy notably enhanced the average lifespan of older glioblastoma patients by several months. Concurrently, the second trial is currently in progress, exploring two treatment modalities for radiation combined with advanced imaging technologies. Notably, El-Afandi opted to enroll in this second trial, and after several tense months, the results from her scans are overwhelmingly positive—showing a clean bill of health, she is now enjoying a much-deserved vacation in picturesque Hawaii.
“I firmly believe in helping others, so finding that something positive could emerge from this terrible situation fills me with genuine happiness,” reflected El-Afandi, who recently celebrated her 61st birthday.
A “very promising approach” to treating glioblastoma
The findings from the initial study were published this week in the esteemed Lancet Oncology medical journal. This study, helmed by Dr. Sujay Vora, the chair of the radiation oncology department at the Mayo Clinic in Arizona, meticulously evaluated the effectiveness of proton beam radiation paired with advanced imaging and the chemotherapy agent temozolomide in treating glioblastomas among patients aged 65 and above.
Traditionally, radiation treatments utilize photon beams; however, proton beam radiation offers a more targeted approach, significantly preserving surrounding healthy tissues, according to Vora’s explanation. This synergistic method, combined with cutting-edge imaging, provided doctors with the capability to precisely target the glioblastoma. Participants in this trial experienced fewer radiation treatment sessions than is customary, benefiting from an elevated radiation dose. Rather than undergoing the standard six-week regimen of daily radiation, patients in this trial participated in daily sessions for a brief span of five to ten days. This innovative approach aimed to evaluate how the 39 patients enrolled in the trial compared against the conventional 6- to 9-month survival rate.
What transpired was “better than what we anticipated,” Vora disclosed. The average survival time for trial participants extended to an encouraging 13 months, with a specific subset of patients—those more prone to radiation and chemotherapy sensitivity—surviving an impressive 22 months. These patients also reported an enhanced quality of life during their treatment journey.
“Overall, it’s a very promising approach,” remarked Dr. Akila Viswanathan, chair of the radiation oncology department at Johns Hopkins and not directly involved in the clinical trial. “Patients find it significantly easier to attend just five treatments instead of daily sessions for six weeks. From a patient-centered perspective, it offers a highly positive approach for maintaining quality of life.”
While Vora’s trial demonstrated significant promise, the treatment methodology is not yet ready to be considered standard care for older glioblastoma patients, cautioned Dr. Helen Shih, medical director of the proton therapy program at Mass General Brigham. Comprehensive studies need to be conducted, alongside the necessary identification of which alterations in the standard care specifically benefitted patient outcomes.
Unfortunately, access to proton beam therapy and many advanced imaging techniques remains limited; Shih noted that currently, there are only 48 centers offering proton beam radiation treatment in the United States, in stark contrast to the thousands equipped to provide standard photon beam treatments.
The study did observe that roughly 10% of participants experienced a condition known as radiation necrosis, wherein the treatment results in the death of tissue. Most of these individuals were successfully treated with steroid medications, while one patient required surgical removal of the necrotic tissue. However, none of the patients faced hospitalization or fatalities as a direct result of this complication. While radiation necrosis also occurs with traditional radiation methods, the higher dosage and compressed treatment timeline may elucidate the increased occurrence rate, as noted by Viswanathan.
Ongoing research to “build upon the work”
A second clinical trial, also conducted through the Mayo Clinic, aspires to “build upon the work” established by Vora’s trial, explained Breen. This second investigation seeks to recruit approximately 170 patients across Minnesota, Florida, and Arizona, once again employing advanced imaging techniques for more precise targeting of the brain. Patients will either receive the shorter proton radiation cycle or undergo a longer course of conventional photon radiation to assess whether the shorter course maintains both safety and efficacy as compared to the conventional longer treatments, Breen elaborated.
Regardless of the radiation technique utilized, the advanced imaging technology empowers doctors to treat a more confined and smaller brain area, ensuring more effective targeting. This trial is currently underway, with Breen indicating that results will likely become available in about three years. Following her surgery in June 2023, El-Afandi was presented with the opportunity to join the trial, during which she underwent six weeks of standard photon radiation treatment. Despite feeling tired during the treatment, she was well-acquainted with some of the side effects stemming from her prior breast cancer treatment.
“It never stopped me,” El-Afandi reflected. “I just continued to garden and welcomed friends over to enjoy my porch.”
Every three months, El-Afandi undergoes new imaging scans to closely monitor any potential glioblastoma growth. In the meantime, she relishes the time spent with her husband and four children, embarking on various family adventures.
“I’m now 17 months post-diagnosis and feeling fantastic,” she shared with CBS News from a Hawaiian catamaran, where she was enjoying snorkeling. “Every day is truly a gift.”
How did participating in the clinical trial at the Mayo Clinic impact Nadya El-Afandi’s outlook on her treatment and overall journey with glioblastoma?
**Interview with Nadya El-Afandi: A Journey from Diagnosis to Hope**
**Interviewer:** Nadya, thank you for joining me today. Your story is both inspiring and incredible. When you received your diagnosis of glioblastoma, what were your initial thoughts?
**Nadya El-Afandi:** Thank you for having me. Initially, it was overwhelming. I had just been through breast cancer treatment, and to be told that I had another aggressive form of cancer was devastating. It felt like a series of punches, but somewhere deep down, I knew I had to stay strong and fight.
**Interviewer:** That strength is evident, especially after participating in the clinical trial at the Mayo Clinic. Can you share a bit about that experience?
**Nadya El-Afandi:** Absolutely. The trial focused on this innovative approach combining proton beam radiation with advanced imaging. After months of uncertainty and anxiety, participating in the trial gave me a sense of control. The treatment felt more targeted, and after just a short period, my scans showed a clean bill of health. I was ecstatic!
**Interviewer:** That’s wonderful to hear! What was it about the trial that made you decide to take part?
**Nadya El-Afandi:** My oncologists explained that this new method had shown promising results in extending survival times for older patients. The idea of needing fewer sessions and receiving higher doses of targeted radiation instead of weeks of treatment was appealing. Plus, I wanted to contribute to research that could help others fighting similar battles.
**Interviewer:** You mentioned feeling genuinely happy that something positive could emerge from such a difficult situation. Could you elaborate on that?
**Nadya El-Afandi:** Yes, of course. I’ve always believed in the importance of helping others. Knowing that my participation in this trial could potentially lead to advancements in the treatment of glioblastoma fills me with hope. I’m truly grateful for the care I received and thrilled that my journey may inspire or help others.
**Interviewer:** Given the encouraging results of your treatment and the studies, what do you think is the future of glioblastoma therapies?
**Nadya El-Afandi:** I believe we’re on the cusp of significant breakthroughs, especially with advanced techniques like proton therapy. However, it’s crucial to continue research and ensure these treatments become widely accessible. We know that glioblastoma is still a tough adversary, but with continued efforts, we can improve outcomes for many patients.
**Interviewer:** Thank you, Nadya, for sharing your journey with us. Your positivity and resilience are truly inspiring, and we wish you all the best in your ongoing journey.
**Nadya El-Afandi:** Thank you! I appreciate the platform to share my story, and I hope it brings hope to others facing similar challenges.
