From 6 weeks down to 10 days: Clinical trial cuts radiation time dramatically

This paid piece is sponsored by Sanford Health.

It started Oct. 22 when Jeff Koehn was shaving in the morning.

He felt a bump on his neck.

He didn’t know what it was, but he knew it was there.

He did the right thing. He didn’t avoid it, and he made an appointment right away with Dr. William Devine, his primary care provider at Sanford Health in Watertown.

“He looked at it, prescribed an antibiotic and a steroid and said ‘If it doesn’t go down, let me know,’” Koehn said.

Days came and went, but the bump stayed. Koehn called his primary care provider once again.

“He saw me right away and was concerned about it. He sent me to Clear Lake to get a CT scan, and he said he didn’t like the results of that. He said it could be leukemia, it could be a few different things, but it was certainly something that was suspicious,” Koehn said.

Devine referred Koehn to the Sanford Ear, Nose and Throat Clinic in Sioux Falls.

“They called me and asked when I wanted to come in, and I said I’ll come in as soon as I can.”

They made an appointment for Nov. 1.

“I feel like they called me before they got the results because they called me like two hours later, and they said they wanted to see me the next day at 3 o’clock. I said OK, I’ll see you tomorrow.

“Then, they called me back again and said ‘We want to see you earlier than that. We want to see you tomorrow morning at 11,’” Koehn said.

Surgery and treatment plan laid out

Koehn made the 100-mile trek south on Interstate 90 to Sioux Falls and met with Dr. Sundeep Alapati at Sanford Ear, Nose and Throat Clinic.

Alapati suspected that Koehn had tonsil cancer that had spread to a lymph node, so he ordered two biopsies — one for the tonsil and one for the lymph node — and preemptively made a surgery appointment for Koehn.

“He scheduled me for surgery before he even had the biopsy,” Koehn said.

The biopsies came back positive, just like Alapati expected.

“Three weeks later, he does the surgery,” Koehn said.

What is the EVOLVE clinical trial?

Koehn stayed in the hospital for a few days to heal. During that time, his providers told him about a clinical trial, EVOLVE, that might be a good fit for him.

Dr. Steven Powell, a medical oncologist at Sanford Health in Sioux Falls, said EVOLVE looks to offer standard cancer treatments but with fewer short- and long-term side effects.

“Throat cancer is probably the predominant cancer we’re seeing here now in terms of the head and neck region. We’ve learned that there’s subsets of these that have a very good prognosis.

“Unfortunately, we treat those patients the exact same way as we treat somebody that has a very aggressive form of cancer, so they get the full intensity of therapy,” he said. “What we’re starting to learn from our research is maybe those patients with less risky disease could get lower intensity treatments and do better.”

Related: Early-phase cancer treatments available at Sanford Health

Powell said the study has been open for about four years.

“It’s constantly, for a lack of a better term, evolving,” he said. “We’re adding different arms to it, hence the name. Anytime we see an impressive new approach that maybe could allow us to decrease the intensity of the treatment, we add it to the study.”

Cutting treatment time

The treatment protocol was developed by Sanford Health radiation oncologist Dr. Miran Blanchard, who practices out of Bemidji, Minnesota.

The way it was explained to Koehn was that a typical radiation treatment often consists of a once-a-day treatment, five days a week for six weeks.

“30 shots,” Koehn said.

However, EVOLVE’s lower-dose radiation treatment is composed of 20 doses, but two a day. It cuts down the treatment time from six weeks to 10 days.

Decreasing the intensity allows for fewer side effects such as trouble swallowing, eating issues and dry mouth.

After Koehn’s initial surgery, he went home for a month to heal. He started EVOLVE on Dec. 18, and the treatment was completed by Dec. 30.

Three months later at his checkup PET scan, he was cancer-free.

He still is today.

Lean on your team

Koehn’s take-home message: If you notice something, don’t avoid it, and trust your doctors.

“One thing that I did was I really trusted Dr. Alapati. You know how you can look up your doctors? You’re like, this is a surgical oncologist that specializes in cancers of the head and neck. This is the dude. This is the guy,” he said through a big, boisterous laugh.

Koehn puts his booming voice to good use. He’s an avid concert and festival goer. He went to two festivals in July – and Las Vegas for a concert. Before his cancer diagnosis, he and his family had planned a trip to Europe.

“When you talk about emotions (through diagnosis and treatment), I was thinking to myself I hope I can live to this trip. I hope that I’m not so sick that I can’t go on this trip,” he said.

He was healthy enough — and then some — to go on the trip.

“When I was on the trip, nobody knew I had recently undergone cancer treatments or anything like that. It was just a normal trip, like anything else. So it hasn’t really affected my lifestyle at all. I’m really glad I was in that trial.”

Small details make a big difference

One thing Koehn said he appreciated was his care team’s commitment to the small details: making someone feel at home through their journey.

“When you go to the radiation clinic, they call you by name. When you’re checking in, you don’t go up and give them your name. They say to you, ‘Hi Jeff, we’ve got you checked in.’

“When you’re sitting there, especially when you’re going twice a day and you have your dietitian appointments, regular doctor appointments, your oncology appointments and your speech therapy appointments, it gets to be a little robotic and a little bit dehumanizing. So it’s really nice to walk in twice a day and know someone knows your name. It made you feel really good.”