Historic use of new therapy gives U of M glioblastoma patient a chance to overcome her condition

A workplace accident that took Oakdale, MN, resident, Linda Tinega, to the emergency room began a journey that would lead her to making healthcare history.

Because she hit her head during the accident, Linda was put through a concussion protocol. The required CAT scan showed that she had an unexpected seven-centimeter (about 2.8 inches) brain tumor, which was completely unrelated to the symptoms she was experiencing from her injury.

Linda then began a fight for her life. “My whole philosophy is that if I’m going to do this, I’m going to do it well,” she said. “I have a 14-year-old son and am willing to do anything that will enable me to live longer.”

Linda had her first surgery on March 14, 2018. “The biopsy revealed that it was glioblastoma – the most aggressive kind – and it was growing very fast,” she said. In addition to surgery, Linda underwent the standard therapy for her brain tumor – chemotherapy and radiation.

Nothing worked.

Transferring to the U
On the recommendation of her neurologist, Neil Dahlquist, MD, who had treated her for a grand mal seizure she had years ago, Linda began seeing neuro-oncologist Elizabeth Neil, MD, at the University of Minnesota. Under Neil’s care, Linda continued standard glioblastoma therapy with temozolomide, an oral chemotherapy agent, in combination with a device called Optune® — a cap with transducer arrays worn on the shaved head. The arrays generate low-intensity, alternating electrical fields called tumor treatment fields.

Unfortunately, this treatment was not effective for Linda’s aggressive cancer. Neil then advised her to enroll in a clinical trial that used an injected virus in combination with an oral anti-cancer drug. When this treatment did not stop Linda’s tumor from growing, Neil referred her to Neurosurgery Department Head Clark C. Chen, MD, PhD.

“The first time I met him was October 3, 2018,” noted Linda. “Since then, I’ve had excellent care from Dr. Chen and his U of M team. You can tell his life goal is to help people with brain tumors live longer … to get the therapies they need.”

Chen performed Linda’s second brain surgery to remove the aggressive tumor. Unfortunately, it continued to grow. “Each time Linda’s tumor came back, it recurred right next to where the previous surgery was,” Chen noted. “That’s not unusual for glioblastoma, which leaves microscopic tumors we can’t see adjacent to the surgical site.”

Trying something new
Linda was running out of options, but Chen wasn’t ready to give up on her. He was prepared to incorporate a brand new, FDA-approved tumor treatment option called GammaTile Therapy™ into her third tumor surgery – and was the first in the nation to do so. “It’s being used in select centers where neurosurgeons and radiation oncologists work closely together,” Chen noted during a WCCO radio interview about Linda’s case. “A radiation oncologist, who usually isn’t part of the OR team, must assist the neurosurgeon in placing the GammaTile.”

Why is that assistance required? “GammaTile contains a radioactive Cesium seed inserted in a titanium capsule that’s embedded in a flexible sponge-like matrix that is ultimately absorbed by the body,” Chen explained. “The GammaTile is placed right next to the surgical site, where it releases intense, targeted radioactivity that decays by about six weeks after surgery, giving the same course of radiation used in the traditional therapy.”

According to Chen, this form of therapy was good for Linda because:

1. the recurrence happened right next to her surgical site and inserting the GammaTile there delivered 2.5 times the radiation intensity than that provided by the more traditional external beam
2. the radiation could be delivered immediately (traditional radiation therapy cannot be administered until the surgical wound heals, which usually takes about four to six weeks), and
3. as the radiation is being delivered, Linda can carry on her normal activities. “She doesn’t have to spend a couple hours each day for six weeks going to and from the hospital to get the traditional radiation therapy,” said Chen, noting that she is also avoiding the typical side effects of that therapy, which in Linda’s case included fatigue and nausea. “Using GammaTile would improve the quality of her life,” he added.

On January 30, 2019, following Linda’s third brain tumor surgery, the GammaTile was placed by Chen with guidance from Kathryn Dusenberry, MD, head of the Department of Radiation Oncology at the University of Minnesota Medical School. “Her tumor was very close to the skin, so we had to contour the radiation in such a way that it avoided radiating the skin,” Chen said. “GammaTile gave us the flexibility to do that.”

Linda has had no side effects from the surgery, other than from the healing associated with her incision. In addition to the GammaTile, her post-operative treatment, directed by Neil, will include a combination of oral and intravenous chemotherapies.

Sharing her story
Although it’s been stressful, Linda had no trouble deciding to share her experience as the first-ever recipient of a GammaTile in the United States. “I’m looking at the long term, not only for me, but for others,” she said. “I want to share my story, so everyone knows about what’s available. It also might help other scientists working on new technology to work harder on their projects – to say, ‘let’s make it easier for patients who are going through all these challenges.’”

Chen is inspired by Linda’s courage and determination and is proud of the role played by his department in her care. “At University of Minnesota Health, our mission is to advance new, safe, and effective therapeutic options for the many brain tumor patients who did not respond to the standard-of-care therapies,” he said in a press release about Linda’s case. “Moreover, the University of Minnesota Medical School’s Department of Neurosurgery has a long-standing history of contribution in radio-biologics. To be the first institution in the U.S. to offer the GammaTile Therapy is particularly satisfying in this context.”