Doctors Make a Scientific Breakthrough in Patient’s Extremely Rare Brain Tumor

At first, the changes were negligible. Bill Glancy of Dayton, Ohio, noticed his eyesight was not what it used to be, but not enough to cause him to worry. 

Over time though, Bill’s visual impairment increased. “My eyesight kept getting worse and worse, particularly for distances,” says Bill. “At traffic stops, I’d have a hard time seeing the lights.” Admittedly, Bill does not like visiting doctors, so he kept telling himself it wasn’t a problem.

At Christmastime, Bill noticed that it was really difficult to see the lights on his Christmas tree. He took one hand and covered his right eye and couldn’t see anything out of his left eye. “I didn’t know what was wrong with me,” he confided. But, he did know it was time to see his doctor.

He met with his ophthalmologist, Dr. Ware, MD, of Dayton who immediately suspected a pituitary tumor. Dr. Ware called a colleague to get his opinion, and the doctor told him, “He needs to see Dr. Forbes at UC Health.”

Jonathan Forbes, MD, a neurosurgeon who is fellowship-trained in skull base tumors, and specializes in the minimally invasive removal of pituitary tumors saw Bill within a few days. In January 2019, Dr. Forbes confirmed what Bill’s eye doctor had suspected: MRI scans showed that Bill had a pituitary tumor and it needed to removed immediately. “I could tell it was getting worse every day,” Bill remembers. “It’s like the walls were closing in.”

Dr. Forbes says it is common for patients with pituitary glands to have difficulty seeing. “The Pituitary gland is just below where the optic nerves join together,” says Forbes. “In terms of tumors that typically cause visual problems, pituitary tumors are one of the most common, if not the most common tumor.”

Dr. Forbes explained to Bill that the tumor would have to be surgically removed. “Dr. Forbes has a calmness, a professionalism about him,” Bill says. “He said, ‘Here’s what we’re going to do, we’re going to attack this.’ He made me feel like we were all on the UC team together.”

Within days, Dr. Forbes performed an endoscopic endonasal transphenoidal resection and fully removed the tumor from Bill’s pituitary gland. Bill felt an immediate sense of relief after he woke up from the surgery. He recalls enthusiastically, “I felt so good; I could see again!”

Prior to the surgery, Dr. Forbes had evaluated images of Bill’s brain. “There was nothing on his MRI that would have suggested a cancerous ideology,” Dr. Forbes noted. Seeing that 99% of pituitary tumors are benign, Dr. Forbes suspected Bill’s would be too. “We were actually quite surprised when the pathologist let us know after the surgery that his tumor appeared to be quite aggressive,” remarks Dr. Forbes.

Not only was the tumor cancerous, it was the most malignant pituitary tumor Dr. Forbes had ever seen in his career. 

“There’s a marker called the MIB, or KI67, that stains cells that are dividing,” Dr. Forbes explains. “A typical pituitary tumor has a KI67 of less than 3%. Mr. Glancy’s KI67 labeling index was extremely elevated, approximately 75-80%. It was a highly cancerous tumor.”

Dr. Forbes knew that Bill would still require much more medical care. “In Mr. Glancy’s case, even though his post-operative MRI was completely free of any residual tumor, we decided to proceed with radiation therapy given the very elevated MIB index and the high likelihood of tumor recurrence.”

Dr. Forbes called Bill at home to tell him the unfortunate news. Bill, a person who speaks openly about his strong Christian beliefs, said, “I’m a person of faith, so, I felt peace. I know when it’s our time, and I’d rather it be me than a child or a parent of a child.” Even so, Bill was determined to fight this.

Dr. Forbes referred Bill to Luke Pater, MD, a radiation oncologist who administered radiation therapy to keep the tumor at bay. For 16 months after the radiation treatments, frequent MRIs showed that the tumor was in remission. “We became hopeful that it might not come back,” recalls Dr. Forbes. But, it came back and Bill knew it. “It got so bad, I couldn’t see again,” Bill laments. 

Drs. Forbes and Pater discussed a number of options to treat Bill, including a possible return to the operating room for surgery and a number of oncological options. Eventually, they decided to take advantage of UC Health’s multidisciplinary approach and sent Bill to see their colleague, neurooncologist Soma Sengupta, MD. “She swung into action! We tried chemo first, but she didn’t think it would do any good,” Bill says. “She pulled me off the chemotherapy, as soon as she saw she was right.” 

Dr. Sengupta analyzed Bill’s tumor and its molecular characteristics. She had it sent for sequencing and immunostaining and those tests indicated that Bill’s tumor was positive for particular immunostain that had a clinical trial running at Memorial Sloan Kettering in New York City. Dr. Sengupta consulted colleagues there and created a similar treatment plan for Bill using a special class of medical agents called immunomodulators which activate the immune system.

Bill’s treatment required 1 cycle of immunotherapy involving 10 rounds of treatment of ipilimumab and nivolumab. “We went on to this immunotherapy, and lo and behold, we fought back,” Bill reported enthusiastically. Not long after starting the trial, Bill’s vision started to improve. At the end of his treatment in the spring of 2021, the tumor was gone and has remained in remission ever since.  

“A number of studies have reported the average survival for aggressive forms of pituitary carcinoma, like the one Mr. Glancy suffered from, as less than 12 months,” Dr. Forbes says. In Bill’s case, he’s more than 3.5 years out from the surgery and more than a year from immunotherapy. We think it is an incredible success story. It’s an important ray of hope for patients who suffer from this condition. The potential these newer medical agents can potentially, dramatically extend the lifespan of individuals who suffer from pituitary carcinoma, and possibly even lead to a cure. We are really optimistic to what this form of technology might bring to patients who suffer from this disease in the future.”

Drs. Forbes and Sengupta wanted other physicians to know about this potential cure for this rare tumor. “We felt like the response Mr. Glancy got to this type of medication was a scientific breakthrough,” says Forbes. “In fact, we published his case report in Neurosurgery, the preeminent journal in the neurosurgery field.”

“It makes me feel wonderful because it is a very aggressive kind of tumor that he has,” says Dr. Sengupta. “His life expectancy was not expected to be great, but he’s superseded that. He always had a positive outlook and he really did trust what we were doing, even though I was very clear that it was experimental and that we didn’t know if he would respond or not. I didn’t want to give false hope. He was willing to try anything. When it worked, and he’s been stable since then, he’s been very, very grateful.” Dr. Forbes adds, “I think it’s unusual to see a response like this. For us, it’s a wonderful success story because Mr. Glancy is such a warm and appreciative individual makes it even better for us.”

A second-generation UC grad, Bill is a proud bearcat. His treatment at UC only strengthens that allegiance. “They made me feel so comfortable. When you see a good doctor, you recognize it. When a person has a passion for whatever they do, it just comes through,” Bill says of his doctors at UC Health. 

Bill continues to get MRIs every 3 months and sees Dr. Sengupta for follow-up care. He doesn’t take his remission and recovery lightly. “I do feel like I’ve been given a second chance,” and he reminds us all, “I think we’re all given second chances, just sometimes we don’t even realize it.”