Emergency responders took Lindsay to Hackettstown Medical Center where an MRI showed a large mass in her brain. She was immediately transferred to the Gerald J. Glasser Brain Tumor Center at Overlook Medical Center and had brain surgery the next day.
“At the time, Lindsay’s tumor was compressing her motor cortex, the part of the brain responsible for controlling body movements. While we needed to preserve the motor cortex, we wanted to push to remove as much of the tumor as possible to have a better long-term outcome. Adding to the challenge, the tumor did not have clear boundaries separating it from healthy brain matter, making a gross total resection even more difficult to achieve,” explains Yaron A. Moshel, MD, PhD, co-director of the Gerald J. Glasser Brain Tumor Center and a neurosurgeon with Altair Health, who led Lindsay’s surgical team.
To define the tumor boundaries during surgery, the team used three-dimensional stereotactic imaging – which combines multiple types of MRIs and 3D images of the tumor – as well as GPS-like technology. They also performed electrical stimulation brain mapping to detect the precise locations of Lindsay’s brain functions. With this hi-tech approach, Dr. Moshel was able to remove all of Lindsay’s tumor and kept all of her neurological functions intact.
Pathology confirmed Lindsay’s tumor was an anaplastic oligodendroglioma, a cancerous and rare type of glioma with a high likelihood of recurrence. She went through chemotherapy and radiation therapy. However, one and a half years later, the tumor returned.
“Lindsay’s treatment course highlights the importance of treating patients individually and tailoring their care to their specific needs,” says Nicholas Metrus, MD, one of only four board-certified neuro-oncologists in New Jersey.
Lindsay’s previous chemotherapy had a side effect of reducing her number of platelets, a vital blood component that prevents bleeding. She needed a second surgery, but having low platelets made this far too dangerous. Dr. Metrus gave her a medication that helped boost her platelet level so she could have surgery. The team then analyzed the tumor tissue from both surgeries to determine which mutations her tumor may or may not have.
“In the past, it was routine to analyze tumor tissue under a microscope and classify it based on its appearance. With our ever-growing knowledge of brain tumors, we now understand this is only a piece of the puzzle,” Dr. Metrus continues. “Molecular information – coming from the presence or absence of different mutations at the DNA level – can tell us so much more about how a tumor may behave and respond to different treatments.”
Genetic testing revealed Lindsay’s tumor had an IDH1 mutation. Using that knowledge to determine the best course of maintenance treatment, Dr. Metrus narrowed his focus on medications that have shown promise in targeting this specific mutation. He selected a drug called Olaparib based on preclinical and clinical trial data that shows IDH-mutant tumors could be vulnerable to this type of medication.
“Lindsay has done incredibly well on this medication,” he adds. “The collaborative effort between neurosurgery, neuropathology and neuro-oncology – backed by cutting-edge technology – played a huge role in controlling Lindsay’s disease for the long term.”
Lindsay says having this expertise at her disposal has been extremely valuable. She has been stable for two years since her second surgery and hasn’t let cancer hold her back. She has been back at school working with students and colleagues she adores. She recently got back from a three-week vacation with her family to her husband’s homeland in Brazil and has several trips planned for the future. Lindsay also serves as a mentor for families who are dealing with the same type of cancer through the Cancer Hope Network.