The couple’s journey began on Jan. 21, 2014. During his daily seven-kilometer run through a park near his home, Velázquez, a healthy 55-year-old, became dizzy and developed uncontrollable shaking in his left leg. The episode was brief, but he lost consciousness and was taken to the emergency room of a nearby hospital, where an MRI of the brain revealed a right parasagittal tumor located on the motor strip, the part of the right frontal lobe that controls left leg movement. Velázquez underwent a craniotomy and biopsy on Jan. 25; two days later, he and his wife heard the diagnosis: WHO grade 4 GBM.
“We knew GBM was not a good diagnosis, so we started asking friends about hospitals where we could have treatment,” Costa says. “A close friend, whose cousin was treated for GBM by Dr. Jay Zhu in Houston, advised us to talk with Dr. Gustavo Ayala, a pathologist from Paraguay who is a professor at UTHealth Medical School. We did, and Dr. Ayala told us yes, you must see Dr. Zhu. So when we came to Houston, we knew only of Dr. Zhu.”
Meeting the Right Doctor
A fellowship-trained neuro-oncologist at the Mischer Neuroscience Institute and an associate professor at UTHealth Medical School, Jay-Jiguang Zhu, MD, PhD, focuses his practice on primary brain tumors and primary CNS lymphomas, as well as brain metastases and leptomeningeal spread of systemic malignancies. Just three weeks after Velázquez and Costa heard the diagnosis, they met with Dr. Zhu and radiation oncologist Angel Blanco, MD, at the Mischer Neuroscience Institute.
“When people in Paraguay, more than 6,000 miles away from Houston, say you will go to the Texas Medical Center, which is well known worldwide, and you will be seen by a person who is renowned, you wonder what kind of people you’ll meet,” Costa says. “We didn’t believe we could get an appointment with such a person as Dr. Zhu in 10 days, but we did. That first sign of hospitality gave us an idea of what we could expect in the future.”
A Decision from the Tumor Board
Later the same day, the Mischer Neuroscience Institute Tumor Board discussed Velázquez’s case and came to a consensus to start standard-of-care treatment – six weeks of conformal irradiation with concurrent temozolomide – as soon as possible. He began treatment the following day.
In May, four weeks after Velázquez completed radiation therapy and the initial course of temozolomide, Dr. Zhu’s team offered him the opportunity to enroll in the NovoCure clinical trial investigating the safety and effectiveness of the NovoTTF-100A, together with temozolomide, in patients with newly diagnosed glioblastoma multiforme. The medical device was FDA approved for treatment of recurrent GBM in April 2014.
A locally delivered treatment, the NovoTTF-100A uses electric fields within the human body to disrupt the rapid division and spread of cancer cells. Developed to provide physicians and patients with a fourth treatment option for GBM in addition to surgery, radiation therapy and chemotherapy, TTF therapy is designed for continuous use during the day and night by patients, with portable battery packs that allow them to maintain their normal daily routine while undergoing treatment. Velázquez will wear the NovoTTF-100A for two years.
“Studies have shown that low-intensity, intermediatefrequency electric fields stunt the growth of tumor cells,” Dr. Zhu says. “The device administers alternating electric fields to the region of the malignant tumor by means of surface electrode arrays. Our entire neuro-oncology team was happy when Carlos was randomized to the treatment arm of the clinical trial.”
Gamma Knife Radiosurgery
In May 2015, when the tumor showed progression, Velázquez underwent Gamma Knife® radiosurgery by Dr. Blanco, who is a clinical assistant professor in the division of Oncology at UTHealth Medical School.
“We weren’t familiar with the Gamma Knife procedure, but we had complete trust in Dr. Zhu and his team,” Costa says. “The procedure was painless, and the result was spectacular. To our surprise, the tumor shrank.”
Following radiosurgery, Dr. Zhu added two additional FDA-approved therapeutic modalities to the NovoCure/ temozolomide treatment regimen – Avastin® and irinotecan. “The combination of these four therapies is one of many things unique about Carlos’ case,” he says.
“This is a very aggressive treatment that I prescribe for younger, healthier patients. Because the combination may have side effects, we follow Carlos meticulously, working closely with his oncologist in Asunción.”
Today, the couple continues to make the trip – 20 hours each way. “It’s a long trip, especially considering that my husband is an oncology patient,” Costa says. “But when Dr. Zhu enters the room smiling, you say to yourself, ‘Well, this is good.’ We expected some kind of very serious and distant doctor. What we found was exactly the opposite. He is so warm and so clear about what we can expect. He finds ways to adjust to your budget or the resources we have in our country without compromising the treatment. So many people think they can’t afford the treatment or maybe they are afraid of the trip. I would like to encourage people not to be afraid of the travel and the language barrier. The hospitality has been wonderful.”
Dr. Zhu says that the couple’s attitude is the key to success, in addition to the therapies. “Carlos is exercising, and he’s very upbeat,” the neuro-oncologist says. “He puts his best efforts into whatever we recommend. His wife is a pillar, and his family provides excellent care and support. They have overcome the barrier of distance because they feel it’s worth the travel and expense to be treated at the Mischer Neuroscience Institute.”
Looking to the Future
For their part, Velázquez and Costa stay focused on their hopes and plans. “We are not only stable, but we are better,” Costa said. “My husband is a wonderful, relentless man. If Dr. Zhu suggests five abdominal exercises, he does 20. He really is a one-of-a-kind man. That, along with the team we have, helps make everything a joy.”
Velázquez remains positive. “I came here with cancer, and I was very anxious but with Dr. Zhu, I feel confident,” he said through an interpreter. “I used to travel a lot in my professional life, and now I travel to get the best treatment. It makes me really tired but we always make a stop in Miami to relax.”
“Cancer is just a disease of the body,” Costa adds. “We will not let the cancer take our spirit, our faith or our souls. So every time we come to Houston, we plan our stopover in Miami, where my sister-in-law lives. We plan where to dine and what to do, so we can have fun along the way. That makes us less anxious. We don’t need anxiety. We need to be sure and calm. As Christians, we don’t believe in coincidences, we believe in ‘Godincidences’ and God led us to Houston. We know the treatment is aggressive and difficult, but we trust Dr. Zhu’s team because we know we are here on earth in the best hands. We pray every day for all of them.”
Carlos Velázquez and Mónica Costa wish to thank all the healthcare professionals at the Mischer Neuroscience Institute – from physicians, nurses and technicians to staff in the Finance Department and International Services – who have helped them along the way. They are especially appreciative of the efforts of Dr. Zhu’s research team for the NovoCure trial, including clinical trial coordinators GuangRong (Greg) Lu and Mayank Rao, and also for the assistance of Amy Luton, technical service representative for NovoCure.