PHILADELPHIA — Every two days, Lynn Oxenberg leans over her bathroom sink while her husband shaves the shadow of auburn hair beginning to cover her head.
Once clean shaven, she sticks to her scalp four tan patches with electrodes designed to keep aggressive cancer cells from growing in her brain.
She stuffs the protruding wires and a 2-pound battery into a mini backpack, then heads to the grocery store, or library, or lunch with friends.
This has been Oxenberg’s routine for six years. It can be arduous, but it’s kept the 73-year-old Elkins Park, Pennsylvania, grandmother alive far longer than most people diagnosed with glioblastoma, an aggressive brain cancer that kills within an average of 15 months.
University of Pennsylvania doctors are now researching whether the treatment routine, paired with highly sensitive MRI monitoring, could one day make Lynn’s experience — living with glioblastoma for years — less of an anomaly.
There is no cure for glioblastoma, and the disease is exceptionally difficult to treat. Glioblastoma is typically treated with a combo of surgery, radiation and chemotherapy, then monitored closely for signs of the cancer growing again. Once the cancer begins to regrow, it is almost always fatal. Treatments can never eliminate all of the cancer because glioblastoma tumors burrow into brain tissue, like an octopus’ tentacles.
Penn researchers are testing whether they can help glioblastoma patients, who have already had treatment to reduce the size of their tumor, to live longer by pairing the Tumor Treating Fields, or TTF, therapy Oxenberg uses with AI-powered MRIs that take a tumor’s “temperature” for highly precise results.
The combination departs from the standard of care for the disease. Instead of waiting for the disease to return and treating it with more chemotherapy or radiation, TTF therapy, from Swiss pharmaceutical Novocure, sends electric fields through the brain to keep cancer cells from growing. The temperature- taking MRIs can show the earliest signs that a tumor is returning and help doctors pivot their care plan.
Suyash Mohan, Penn’s director of neuroradiology research, calls it a “whole brain” treatment that could be more effective than attempting to isolate a tumor. TTF therapy keeps cancer cells in check.
Novocure’s FDA- approved TTF 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% to 80% of the time lived an average of 21 months, compared to 15 months among patients who received standard treatment. But the device can be cumbersome: Patients must shave their heads to glue electrodes in place. Unlike medications that remain in the body hours or days after being taken, Optune only works when being worn.
Some experts say that while the results are promising, convincing patients to take such aggressive measures can be hard. The treatment is covered by Medicare and many commercial health plans, but costs $21,000 a month without insurance.
It’s unclear whether the approach will ever lead to a significant change in the outlook for glioblastoma patients. But Mohan thinks the work is a glimpse at the possibility that someday, one of the most notoriously aggressive cancers could be treated as a chronic condition.
“The overall survival of this disease hasn’t changed in the last 25 years,” Mohan said. “We have to reassess how we approach this tumor.”
Novocure’s executive chairman, William Doyle, agrees that there’s room for improvement. The company is designing thinner head patches and exploring whether they can increase the power delivered through the patches, which would reduce the amount of time patients must wear the device.
The company is also working on an app that would help patients track how long they’ve worn the device.
Optune’s gauze head wrap and mini backpack can make it possible for glioblastoma patients to survive long enough to make it to important family milestones, like a child’s graduation or wedding, Doyle said.
“You can live with this” is the message the company sends patients and doctors, he said.
Oxenberg was diagnosed in December 2017, and after she’d had surgery and as much chemotherapy as her body could tolerate, her doctor suggested she try Optune. Oxenberg agreed.
She began her treatment in April 2018 and still wears the device 90% of the day.
She was reluctant to part with the red hair that had been her identity since the maternity ward nurses paraded her around to show off the fiery fluff sticking out of the hospital’s swaddling blanket.
“I realized my hair was overrated,” she said.
It’s a trade Oxenberg says she is willing to make for more time with her husband, children and grandchildren.
Earlier this summer, all 10 of them headed to North Carolina’s Outer Banks for their annual summer vacation. The sun and sea breeze felt different against her exposed scalp. And she soaked it in.