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One evening in December 2017, Nadine Dio was applying face cream when she felt a lump on the right side of her neck. “Being afraid, I didn’t do anything about it for a few months,” says the 52-year-old longtime wedding florist. In May 2018, a CT scan revealed that the lymph nodes in Dio’s neck were enlarged. A biopsy led to a diagnosis of adenocarcinoma, a cancer that forms in glandular tissue, which was believed to have spread to the neck from an unknown origin.

Dio lives in Greenlawn, a hamlet in Suffolk County on Long Island, but in July, she was referred to a medical center in Manhattan, where she was treated for head and neck cancer with six cycles of the chemotherapy drugs paclitaxel and carboplatin. By February 2019, blood markers indicated that her cancer was progressing. Dio’s oncologist told her that nothing else would work for her. “The news just broke my heart,” she says. “My father had to bury one of his two children, and I was determined that he wouldn’t have to do that again.”

For guidance, Dio reached out to her stepmother, who contacted Birjis Akhund, MD, a medical oncologist at Perlmutter Cancer Center at ��ɫtv Langone Huntington Medical Group. When Dr. Akhund learned of Dio’s request for a second opinion, he arranged to see her as soon as possible. “I met Dr. Akhund on February 11, my birthday,” recalls Dio, “and I couldn’t have asked for a better present than to meet a new doctor who wanted to look at my case. I thought, ‘Wow, this doctor really cares about me, and he hasn’t even met me. I have hope now.’”

“Dr. Akhund and his team are amazing. It was that second opinion that saved my life.”
—Nadine Dio

Initially, Dr. Akhund felt that Perlmutter Cancer Center could at least offer Dio good supportive care, but after he met with her and pored over her medical history, he became more optimistic about her prospects. “I look at a case really carefully,” says Dr. Akhund, clinical assistant professor in the at ��ɫtv Grossman School of Medicine. “I start at the very beginning. It’s like a puzzle. You put it all together, and sometimes, suddenly, a door opens.”

Dr. Akhund was struck by several things that made him question Dio’s original diagnosis. Head and neck cancer, he explains, is sometimes associated with the human papillomavirus (HPV), but Dio’s biopsy results were negative for HPV. Moreover, this type of cancer usually strikes people who are not only longtime smokers but also heavy drinkers, and while Dio had a history of smoking, she did not fit into the latter category. Also, a patient in their late 40s would be considered young for head and neck cancer, which is more commonly found in people in their 60s and 70s. Most telling of all, Dr. Akhund knew that head and neck cancer is invariably squamous cell carcinoma, a form of skin cancer, rather than adenocarcinoma. “While no primary tumor was identified, which is true in about 15 percent of all cases, the nodes in the lower neck were involved,” notes Dr. Akhund. “This suggested that locally advanced lung cancer had spread to the lymph nodes rather than the other way around.”

Dr. Akhund discussed Dio’s case with Perlmutter Cancer Center’s Tumor Board, a multidisciplinary team of experts who review challenging cases. “It was about rethinking the strategy and saying, ‘Do we have something that can cure this?’” says Dr. Akhund. “Nadine was young and otherwise healthy. So I thought, ‘We might be able to beat this.’ It’s never too late. You never take hope away.”

Dr. Akhund explained to Dio that the plan was to start from scratch. The disease would be reclassified as stage 3B non-small cell lung cancer, and the treatment regimen would be aggressive. To destroy the cancer cells, Dio was administered high doses of two potent chemotherapy drugs, cisplatin and pemetrexed, along with radiation therapy to the lungs and lymph nodes in the neck. Then she was given the immunotherapy drug durvalumab, a so-called checkpoint inhibitor that blocks proteins that prevent the immune system from attacking cancer. “If we used only chemotherapy and radiation,” explains Dr. Akhund, “the likelihood of a recurrence would be 85 to 90 percent. This is what makes us a great cancer center: being able to look at a case through a different lens from multiple perspectives.”

Dio’s follow-up scans have shown no signs of cancer since October 2019, but she remained on immunotherapy for two years afterward to ensure a sustained period of remission. “I want to help people who have that same feeling of hopelessness I had when I was told that they could only buy me time,” she says. “Dr. Akhund and his team are amazing. It was that second opinion that saved my life.”