Trial Improves Life Quality of Tongue Cancer Patient

Vance Aldrich Bell III of Washington, North Carolina was having a routine dental visit in the summer of 2018 when his dentist saw a suspicious lesion on his tongue. Bell was urged to keep an eye on the spot after a biopsy indicated that it was benign.

His tongue began to feel funny three years later. It swelled to the size of a lime. He began to have difficulty speaking and swallowing. He was sent to an urgent care center, then to a local ENT physician, who took another biopsy of his tongue. He was diagnosed with squamous cell carcinoma, a cancer that forms in skin cells and the linings of the digestive and respiratory tracts, that had spread to neighboring lymph nodes in the neck, not long after.

“I just remember kind of going blank and not really hearing much beyond ‘cancer,’” said Bell. “I don’t really remember feeling much – it just takes the wind out of your sails, so to speak. It was like a gut punch.”

Bell was aware that he would need surgery to remove the malignancy from his tongue. His friends recommended a few physicians, but he ultimately chose Wendell G. Yarbrough, MD, MMHC, FACS, a skilled head and neck surgeon at UNC Hospitals.

“I think he had close to a 5 or 6 cm tumor,” said Yarbrough, who is the Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery in the UNC School of Medicine. “With a tumor of that size, you can imagine that a lot of his tongue would have to be excised to remove the tumor, and then, after that, people frequently get radiation or chemotherapy, and we take out lymph nodes in the neck.”

But Yarbrough had a different plan. He was aware of an induction treatment clinical trial that was still admitting subjects. Induction therapy is a brief course of medications, in this case two low-dose chemotherapy agents and immunotherapy.

The clinical experiment, conducted by Jared Weiss, MD, an oncologist at the UNC Lineberger Comprehensive Cancer Center, aimed to decrease the tumor as much as possible prior to surgery in the hopes of making the surgery more effective and less invasive. More importantly, it may reduce the need for radiation after surgery, which may result in debilitating side effects such as necrosis of the jaw, dental issues, dry mouth, speech and swallowing problems, and even aspiration – when food enters the airway and becomes lodged.

“The trial is only six weeks of low dose weekly therapy, and, critically, it’s not leading to permanent harm to quality of life,” said Weiss, who is a professor of medicine and the section Chief of Thoracic and Head/Neck Oncology in the Department of Medicine. “The goal here was to not only cure more patients, but to improve their long-term quality of life by either omitting radiation therapy entirely or by limiting the field size in those who had some response.”

Bell spoke with Weiss to learn more about the research trial. For the first time since his trip to the dentist, he recognized he wasn’t a number and that Weiss, Yarbrough, and the other medical professionals at UNC actually cared about him.

“Early on, everyone else’s answer or plan was surgery and radiation,” said Bell. “Dr. Yarbrough was receptive and shared the idea of a potential trial and Dr. Weiss was very personable, intelligent, and able to ‘dumb down’ really difficult concepts for me. Finding people that genuinely care about you puts you in a better place than feeling like you’re just a number.”

Bell decided to participate in the trial after much thought and prayer. Over the course of six weeks, he got low-dose carboplatin, nano-albumin bound paclitaxel, and durvalumab treatment. His reaction was extraordinary. His tumor has reduced from 5 cm to 1.5 cm in size, or roughly the size of a peanut.

Because of the favorable response, Yarbrough and his surgical team did a smaller surgery than they had planned. They simply needed to take out around half of Bell’s tongue. They also revealed that his lymph nodes were negative at the time of surgery, which could have been caused by induction therapy.

The reconstruction of his tongue was then assigned to Catherine J. Lumley, MD, assistant professor in the Department of Otolaryngology. She extracted skin, muscle, and arteries from Bell’s left wrist and restored the second half of his tongue. She then removed all of the lymph nodes in Bell’s neck in order to eradicate any malignancy that might be there. Overall, Bell’s reaction was so strong that he was able to avoid radiation entirely.

“I won’t say I’m 100% the same as I was pre-surgery,” said Bell. “Obviously, my tongue is different and I have a scars on my neck and arm that others don’t, but I don’t have any limitations to speak of. There are some things that may be harder to do now, but I feel like I’m very blessed to have landed at UNC Health and receive such a high level of care.”

Bell is only one of several successful trial participants in this trial. Some participants had a “complete response” to the induction therapy, which means there is no tumor remained, even when examined under a microscope. It begs the issue of whether this could become a new treatment standard for squamous cell carcinoma patients.

“We’ve had a few people who’ve had complete responses after induction therapy,” said Yarbrough. “I think this is going to be part of our treatment in the future. The real question for us is, which patients should get induction therapy? Who’s going to respond to this therapy? And who’s not going to respond?”

Bell has been cancer-free for two years. Bell is eternally grateful to his wife Sara, who helped him spiritually, physically, and mentally by caring for his wounds and keeping a cheerful attitude throughout his medical journey. He also regularly recalls his profoundly intimate patient experience at UNC.

“It isn’t just a medical appointment when I visit UNC Health,” said Bell. “Dr. Yarbrough and I talk about UNC basketball. Dr. Weiss and I talk about poker. I got to know these people and they got to know me. For me, it was important to find the right team that genuinely cares – they helped me recognize that although cancer is bad, it isn’t the end. They are just good people and they’re a great team.”

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