The Christie NHS Foundation Trust in Manchester is leading a groundbreaking clinical trial that could transform the treatment of glioblastoma, the most aggressive and deadly form of brain cancer.

Known as PORTRAIT, the trial is recruiting newly diagnosed patients to explore whether treatment can begin immediately after diagnosis—before surgery and radiotherapy—using an innovative, non-invasive technology.

Tumour-Treating Fields (TTFields), is an anti-cancer therapy that uses electrical fields to disrupt tumour cell division, slowing or stopping tumour growth. Delivered through adhesive patches worn on the scalp, TTFields therapy is traditionally used after surgery and radiotherapy. PORTRAIT is the first study in the world to investigate whether starting this treatment earlier—while patients await surgery—could improve outcomes.

One of the first patients to be recruited onto the PORTRAIT trial is Andy Bradley, 58, a chartered surveyor from Knutsford in Cheshire. The married father of two grown-up boys was diagnosed with a glioblastoma at the beginning of February this year.

“This diagnosis came completely out of the blue.” Andy explained: “I didn’t have headaches or any symptoms at all. I’d just played my best game of football in ages with my Sunday five-a-side team and was laughing and joking with the lads afterwards.  Then, when I got home, I had what I can only describe as a surge of energy which was absolutely terrifying. I couldn’t regulate my voice and had a strange sensation of wanting to stand on the coffee table and shout.  As we didn’t understand what was happening, my wife, Lisa, drove me to A&E where they thought I was having a mini-stroke. The episode lasted three hours before I was back to normal. Luckily they decided to keep me in for further investigations and it was then I got the bombshell news I had a brain tumour. It was a complete shock as I’m quite health conscious, watch my weight and exercise regularly.

Hope for the future

“I was referred to Salford Royal where I met Dr Borst for the first time and agreed to take part in the trial. I started wearing the TTFields device pre-op. It’s a little frustrating to be wired up but a minor inconvenience. It’s nice to have a half hour of relief from it when I shave my head every few days but I can’t wait to get it back on to continue to attack whatever is there.

“I opted to stay awake during the operation to protect as much of me post-surgery as possible which was very surreal and a life-changing experience. Fortunately, the surgeons managed to remove a substantial part of the tumour. I feel lucky to have the opportunity to wear the TTFields as it helps me stay positive as I feel I’m doing something proactive about the problem.

“It’s been a very positive process so far.  I always get up early and banish any maudlin thoughts, and just get on with the day. I’m also back working again.  Lisa has been so strong for me. She, the boys and close friends have been a fantastic support.  I’m thankful for the trial, and not only hope it helps me, but others in a similar situation in the future.”

Glioblastoma is highly aggressive and incurable, with fewer than 10% of patients surviving beyond five years, even with the best available treatments.

“Glioblastoma remains one of the most challenging cancers to treat, despite decades of research,” said Dr Gerben Borst, consultant oncologist at The Christie and senior lecturer at The University of Manchester, who is leading the study. “By starting treatment before surgery, we hope to prevent tumour cells from becoming more aggressive after the surgery while patients are recovering before their standard radiotherapy. If successful, the concept of treating patients before surgery could revolutionise the way we treat brain tumours in the future.”

Unlike chemotherapy or radiotherapy, TTFields therapy does not cause many of the debilitating side effects associated with conventional cancer treatments. Patients wear the device for at least 18 hours a day, with a portable battery-powered system allowing them to continue everyday activities such as shopping, gardening, cycling, and socialising.

Currently, glioblastoma treatment typically involves surgery followed by radiotherapy and chemotherapy. However, after surgery, patients often wait four to six weeks before starting further treatment, during which time residual tumour cells can begin growing and become even more aggressive.

Dr Borst, whose research is part-funded by The Christie Charity, explains: “Because brain tumours infiltrate healthy brain tissue, neurosurgeons cannot remove all tumour cells. By introducing treatment as early as possible, we aim to stop tumour growth before it gains momentum. My hope is that this study will inspire future research to reshape how we approach glioblastoma treatment.

 “We are excited to see whether TTFields therapy can be safely introduced before surgery and radiotherapy. Starting treatment before surgery could be a game-changing step forward in improving survival rates and quality of life for glioblastoma patients. If the PORTRAIT trial is successful, it could pave the way for a new era in glioblastoma treatment, offering patients a potentially life-extending therapy much earlier in their treatment journey.” Dr Borst concludes.

Patient insights

Grant Stobart, 61, the patient representative involved in the study setup, was diagnosed with glioblastoma more than two years ago. He has been wearing the TTFields device for 18 months and played a key role in designing the trial. His insights have helped ensure the patient experience is central to the study.

“Wearing the device took some getting used to, both for me and my family,” said Grant. “I focus on wearing it as much as possible and adjusting to the patches. There have been some lifestyle changes—I need to keep my head shaved, avoid excessive sweating, and monitor the battery life—but it hasn’t stopped me from leading an active life. I still travel, walk to stay fit, and recently enjoyed a family holiday in Peru. I’m also looking forward to my son’s wedding in South Africa.”

While TTFields therapy is not currently available on the NHS, previous research has shown that introducing it about four months after surgery improves survival rates. The PORTRAIT study aims to go even further—testing whether bringing treatment forward to the moment of diagnosis can delay tumour progression and enhance surgical outcomes.

Professor Pietro D’Urso speaking on behalf of the neurosurgical oncology team at Salford Royal where the surgery took place, said: “Due to its infiltrative nature and irregular growth patterns, Glioblastoma treatment remains a major hurdle in neuro-oncology.”

Collaborative approach

The PORTRAIT trial represents a promising step forward in addressing this challenge. One of the key strengths of the PORTRAIT trial is its synchronized, team-based collaborative approach, between neurosurgical and neuro-oncology teams. Moreover, the trial underscores the importance of a combined research effort, integrating cutting-edge technologies and expert-driven methodologies. By fostering a collective approach among researchers, clinicians, and imaging specialists, PORTRAIT has the potential to establish a new standard in glioblastoma treatment.

While there is still much work to be done, the hope is that this trial will mark a significant step forward in the management of glioblastoma. The success of PORTRAIT could lay the foundation for future advancements in neuro-oncology, reinforcing the critical role of collaboration in tackling one of the most challenging malignancies in modern medicine.”

Professor Andrew King, Co-Director of the Geoffrey Jefferson Brain Research Centre said: “This innovative work is precisely the sort of novel patient-centred research that the Geoffrey Jefferson Brain Research Centre is committed to. Gerben Borst has an impressive track record in such innovation with pre-surgical treatment of glioblastoma. We hope this study will make a real difference to patients’ lives in the near future.”

The PORTRAIT trial is the first trial of its kind, and it is currently available exclusively in Manchester. Surgery for participating patients takes place at Salford Royal, part of the Northern Care Alliance NHS Foundation Trust, a leading centre for neurosurgery. The study involves collaboration between oncologists, neurosurgeons, neuroradiologists, and neuropathologists.

The PORTRAIT trial is only open to newly diagnosed glioblastoma patients who have not yet undergone surgery and are not in immediate need of emergency surgery. For more information, interested patients should consult their local oncologist or GP.

The Christie NHS Foundation Trust is the study’s research sponsor. In total 14 patients will be recruited to the PORTRAIT study.

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