Hope for Metastatic Breast Cancer Patients
- A young mother in Arizona diagnosed with metastatic breast cancer is showing no signs of disease after undergoing chemotherapy followed by an immunotherapy drug called Keytruda.
- Metastatic breast cancer, also called "stage four" breast cancer, occurs when the cancer has spread, or metastasized, beyond the breasts to other parts of the body. It most commonly spreads to the bones, liver and lungs, but it may also spread to the brain or other organs.
- Immunotherapy treatments, like Keytruda and others, have been a successful treatment option for some metastatic breast cancer patients. It’s important to always ask your doctor about your treatment options including approved therapies and clinical trials.
Reilly was diagnosed with breast cancer in 2017 after having pain in her bones. Following the diagnosis, the young mother from Phoenix, Arizona, was feeling rather hopeless.
Read More"My liver cleared up completely with the chemotherapy, and even my bones were starting to show that it was getting smaller," Reilly said. "After about eight months, it stopped working. It was just kind of staying there, and the chemotherapy was really taking a toll on me… That's when my doctor decided I would be a great candidate for immunotherapy, which at the time, it was only used for certain types of lung cancer and skin cancer."
That’s when Reilly began taking an immunotherapy drug called Keytruda at the Cancer Treatment Centers of America, Phoenix. Crazily enough, it worked with no adverse side effects. And she just found out her scans showed her cancer was gone two weeks ago.
"[Her doctor] said, 'you have what we call no evidence of disease, meaning that the scans and blood work shows there's no evidence of disease in your body,'" Reilly explained. "She said that this would have never happened with chemotherapy. Immunotherapy is 100 percent to credit for this."
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Staying the course, Reilly is continuing the same treatments every six weeks. But this, she said, is a choice that’s entirely up to her.
"She basically said there's just no info on what the next step is here because it's so new," Reilly said. "They're just taking educated guesses to try and guess what's going to happen, so in a sense, we're writing the book as we go."
But despite the unknown, Reilly feels like she’s “[won] the lottery,” and she’s sharing her story to provide hope for others faced with the same advanced disease.
"It's hard to describe. It's the most incredible feeling. It's something I prayed for year and years and years," she said. "I just want people to understand; there's hope… There's so many options for you, and never give up on it. Right when you think you can't go on, that's when the miracle happens.
"I can't tell you how many people have messaged me and have gotten a hold of me and said we have prayer circles going on. Our church prays for you. It's brought me so much closer to my faith."
Understanding Metastatic Breast Cancer
Metastatic breast cancer also called "stage four" breast cancer means that the cancer has spread, or metastasized, beyond the breasts to other parts of the body. It most commonly spreads to the bones, liver and lungs, but it may also spread to the brain or other organs.
When Breast Cancer Spreads to the Bones
Metastatic breast cancer is generally considered to be “incurable” at the moment, but there are a wide variety of treatment options used to battle the disease including hormone therapy, chemotherapy, targeted drugs, immunotherapy and a combination of various treatments.
And immunotherapy, in particular, has been making waves like we saw in Reilly’s case. We’ve even seen immunotherapy cure metastatic breast cancer survivor Judy Perkins but we’ll talk more about that in the immunotherapy section below.
In a previous interview with SurvivorNet, Dr. Elizabeth Comen, an oncologist with Memorial Sloan Kettering Cancer Center, explained how she tries to manage breast cancer when it has progressed to a later stage.
"With advanced disease, the goal of treatment is to keep you as stable as possible, slow the tumor growth and improve your quality of life," she said.
The American Cancer Society reports that there were more than 3.8 million U.S. women with a history of breast cancer alive at the start of 2019. Some of the women were cancer-free, and others still had evidence of the disease, but they also reported that more than 150,000 breast cancer survivors were living with metastatic disease, three-fourths of whom were originally diagnosed with stage I-III. And with ongoing advancements in treatments and options out there today that can dramatically reduce symptoms, there are many reasons to be hopeful.
Immunotherapy and Breast Cancer
One big reason to be hopeful, as Reilly’s cancer journey proves, is because of advancements in immunotherapy. For Reilly, the immunotherapy treatment Keytruda (pembrolizumab) was the answer.
Currently, the FDA has granted approval for its use in treating high-risk, early-stage, triple-negative breast cancer (2021) as well as locally recurrent unresectable (not capable of being surgically removed) or metastatic triple-negative breast cancer that has the PD-L1 protein (2020). There are also various clinical trials for the use of Ketruda to treat other types of breast cancer.
Keytruda is Not for Everyone Immunotherapy Needs to Be Tailored
And this therapy has actually gained more and more U.S. Food and Drug Administration approvals to treat various types of cancers outside of breast cancer.
"Previously, (Keytruda) was used only for metastatic disease, but it's shown such a good response there (treating early-stage triple-negative breast cancer) that now is used for earliest-stage disease, not because they have metastasis, but because it's now been shown to reduce the risk of metastasis occurring," Dr. Wui-Jin Koh, senior vice president and chief medical officer at the National Comprehensive Cancer Network, previously told SurvivorNet.
It’s also important to note that Keytruda is not always right for everyone, and it is just one of many immunotherapy options out there. And Reilly isn’t even the first woman with metastatic breast cancer to be cured with immunotherapy. That title belongs to Judy Perkins.
In 2003, Perkins was diagnosed with early-stage ductal carcinoma in situ, or DCIS, breast cancer. (DCIS is a non-invasive breast cancer.) Her diagnosis prompted her to get a mastectomy breast cancer surgery that removes the entire breast. But in 2013, her cancer came back, and this time, it was metastatic, or stage 4.
The standard treatment options (like chemotherapy and targeted therapies) were unsuccessful for Perkins, but she learned of an immunotherapy trial at the National Cancer Institute, which is part of the National Institutes of Health in Bethesda, Maryland, in 2015. (There are several immunotherapy clinical trials currently underway as well.)
Understanding How Immunotherapy Works
The specific immunotherapy trial Perkins was part of, and is still part of today, is a type of adoptive cell therapy known as tumor-infiltrating lymphocyte, or TIL, therapy. During the trial, doctors removed some of her T cells, identified the ones which could recognize the cancer and then harvested those in a lab. Several months later, the cells were infused back into her body to attack the tumors. Thankfully, the treatment was a success, and Perkins has been cancer-free since 2016.
Dr. Steven Rosenberg, chief of surgery at NCI and a pioneer in the field of immunotherapy, tells SurvivorNet that Perkins was one of the first patients "to teach us that by carefully looking at (her) body's immune cells, we could identify cells that uniquely recognize her cancer, and by growing them in a lab and giving her enough of them, we could actually cause the cancer to regress completely."
Tumor-infiltrating lymphocyte therapy is still considered an experimental treatment that's being developed for treating solid tumors; there are various ongoing clinical trials using TIL therapy in solid tumor cancers, as well as blood cancers. Perkins says, "I'm a very weird anomaly," as the treatment worked extremely well for her, but not so much for others in the clinical trial. But it should be noted that TIL therapy is showing great promise.
Overall, it’s important to ask your doctor about your treatment options for metastatic breast cancer. And if you’d like to search for clinical trials that are currently recruiting, you can visit clinicaltrials.gov and search “metastatic breast cancer.”
Contributing: Sydney Schaefer
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