Oklahoma Bio-Medical Science Teacher Enrolls in Phase I Clinical Trial After Cancer Diagnosis

Paula Sendall had a small nodule inside her cheek on the left side of her face. Her dentist was sure it was just a cyst, so it was left alone for almost 20 years. In 2015, with the nodule getting bigger, Paula went to see an oral surgeon. She was scheduled to have the nodule removed, but after a complication with the intravenous line, the procedure was delayed, and Paula put off removing what she believed was a benign cyst.

At Christmas 2016, Paula, her mother and daughter were involved in a serious car accident. Her mother was badly injured, and Paula spent most of 2017 helping her recover. It wasn’t until the end of 2017 when she was 50 years old, that Paula had the cyst biopsied and removed. The excision went well, and Paula healed quickly, however, a couple of weeks later she received a call from her oral surgeon — what they thought was a cyst was in fact, adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is a rare and aggressive form of cancer that usually starts in the salivary glands or parts of the head and neck. ACC can also develop in other parts of the body, such as the breast, lungs, skin, cervix in females, prostate gland in males, and other areas. ACC grows slowly but even after treatment, there’s a high chance it will come back.

A friend who works in the cancer field heard about Paula’s cancer diagnosis and recommended that she transfer her care to OU Health Stephenson Cancer Center. Stephenson Cancer Center is Oklahoma’s only National Cancer Institute-Designated Cancer Center.

“From the time I walked into the Stephenson Cancer Center I had a really different feeling about it,” said Paula. “It’s light and bright and there’s something about the environment that makes you feel not so sick.”

OU Health head and neck cancer surgeon, Dr. Nilesh Vasan, M.D., FRACS, professor in the Department of Otolaryngology - Head & Neck Surgery at the University of Oklahoma College of Medicine, explained to Paula that even though the tumor had been removed, there would be cancerous tissue remaining that needed excising. The oral surgeon had only removed what was considered a cyst, not any surrounding tissue.

Facial Surgery and Cancer Treatment

Paula teaches biomedical science at a high school in Choctaw. The program is designed for students who may be interested in pursuing careers in health and medicine and Paula has been teaching for 31 years. A passionate teacher who is reluctant to miss school, Paula scheduled the surgery to remove any remaining cancerous tissue from her face during the 2018 spring break.

“I had a plan that I’d have the surgery during spring break, spend two weeks recovering, and then go back to teaching part-time for a while,” shares Paula. “Before the end of the school year, I planned to have returned to full-time teaching. Sadly, that didn’t happen.”

The 15-hour procedure involved the removal of a lot of cancerous tissue and facial reconstructive surgery. Paula came out of surgery with 50-60 sutures in her head and spent five days in the intensive care unit.

In April 2018 Paula had recovered enough to start eight weeks of chemotherapy with 30 rounds of radiation, and at the end of 2018, the cancer was stable enough that she was able to go back to teaching.

The Return of Cancer

Paula had a check-up with her head and neck surgeon in May 2020, which was three months later than originally planned due to the COVID-19 pandemic. A chest X-ray revealed bad news — the cancer had returned in Paula’s chest. A follow-up scan showed multiple lesions in both sides of her lungs, so surgery was not an option, and neither was radiation. Another small tumor was found near her eye.

“I always expected that the cancer would come back. Although adenoid cystic carcinoma grows very slowly it has a high prevalence of returning, but I thought I’d have maybe 10 or 15 years before it came back. I was not expecting it to be so soon,” said Paula.

During this time, Paula’s family struggled with the tragic loss of people they loved, and Paula’s daughter was graduating high school. It was a difficult and emotional time for the family.

Paula started a strong treatment regimen in July 2020 which involved three different chemotherapy drugs for five months. A scan in November showed that the tumors were stable and didn’t appear to be growing so Paula was able to stop treatment. While the tumors were still there, the hope was that the chemotherapy had slowed down the growth and would hold it off for as long as possible.

However, only a year later, in December 2021, a scan showed that the cancers in her lungs were getting bigger and the chemotherapy regimen she had been on in 2020 wasn’t an option. Paula started on an oral chemotherapy drug in January 2022, on the lowest dose for six weeks. The dose was slowly increased over a few months and once Paula was at the higher dose the tumors started to shrink. Unfortunately, Paula was unable to tolerate the side effects at the higher dose, so it was lowered several times. Paula was taken off the drug when the scan showed the cancer was growing at the lower dose.

Paula’s oncologist recommended she enroll in a clinical trial at Stephenson Cancer Center as part of the Oklahoma TSET Phase I Cancer Clinical Trials Program.

Phase I Clinical Trials

Phase I clinical trials are usually the first study that includes people and tests new treatments. They test the safety, best dose, side effects, and the timing of the treatment. They find the highest dose of the new treatment that can be safely given with the least amount of harmful side effects. Initially, the treatments are tested in labs and animal studies before they are tested in Phase I clinical trials on small numbers of patients. The trials include patients who have not been helped by standard treatments and they can also include healthy volunteers.

Clinical trials are important for discovering new treatments for diseases. This includes new medicines and new diagnostics and improving screening technologies. Clinical trials not only offer cancer patients treatments not available elsewhere, but they also pave the way to help countless other cancer patients in the future.

According to the National Comprehensive Cancer Network (NCCN), access to clinical research is the best way to take care of a patient with cancer. Patients with cancer often receive a higher level of care just by being on a clinical trial because of the requirements for close monitoring and follow-up. Being part of a clinical trial gives patients options outside the standard of care, which is especially important for patients where there are typically modest to low outcome rates.

Paula started a clinical trial of immunotherapy in October 2022. Immunotherapy is a type of cancer treatment that boosts your body’s immune system to help it recognize and attack cancer cells. It uses substances that are either made in the body or in a lab, and they boost the immune system overall or help it to better target cancer cells.

Paula had immunotherapy treatment every 21 days. After each treatment session, she was observed for seven hours, and she’d use the time to grade papers, hold Zoom meetings with her students, or relax with a book. As there is a lot of monitoring with clinical trials, Paula had regular scans and blood tests. A scan in July 2023 revealed that there was a 16% increase in the cancer growth, so the trial was stopped.

A Different Clinical Trial

OU Health hematologist and oncologist, Dr. Abdul Rafeh Naqash, M.D., assistant professor in the Department of Internal Medicine, Section of Hematology-Oncology at the University of Oklahoma College of Medicine, and director of immuno-oncology and medical oncologist in the Oklahoma TSET Phase I Cancer Clinical Trials Program, placed Paula in a different clinical trial.

Targeted therapy differs from standard chemotherapy. While chemotherapy kills both cancer cells and healthy ones, targeted therapy focuses on specific genetic changes, proteins, and markers in cancer cells. This approach minimizes damage to normal tissue and reduces side effects. Paula’s cancer-care team had studied her pathology and identified the genetic patterns of the cancer.

Paula started the targeted therapy clinical trial in August 2023 which involves treatment on day 1 of each 21-day cycle and regular blood tests and monitoring. The drug being tested targets a protein called MDM2. The powerful drug degrades the protein which helps to activate another protein called p53 — p53 is a protein that suppresses tumors and helps prevent active cancer. Paula reports minimal side-effects to the medication and is back to teaching full-time.

A scan in May showed that while the cancer is still there, it has decreased in size by up to 14%. Paula looks and feels well and is hopeful that the cancer will continue to decrease.

“I’m realistic that because of the type of cancer it is, that it can come back or start growing again at any time,” Paula said. “I am so blessed to be a patient at Stephenson Cancer Center. All my nurses have been fantastic, and my doctors feel like friends. I am in the place I am supposed to be, and this journey has been both humbling and reassuring to me.”

Full of Hope

“Stephenson Cancer Center is the only NCI-Designated Cancer Center for the state,” said Dr. Naqash. “We offer a wide array of standard-of-care treatments and multidisciplinary care, as well as a broad portfolio of clinical trials, ranging from early-phase trials with novel experimental therapies to late-phase trials, to bring appropriate therapies to the frontline and help patients live longer and better.”

Paula is grateful for her friend’s recommendation to seek care at Stephenson Cancer Center.

“In the beginning I had so many people tell me that I should be going to Houston to get a second opinion, but I’ve never felt as though I needed that,” explained Paula. “The level of care I have had at Stephenson Cancer Center has never been anything less than top notch. I cannot express in words what being a patient here has meant to me.”

Learn more about comprehensive, multidisciplinary cancer care close to home, request an appointment or get a second opinion, or ask about our clinical trials at (855) 750-2273.