LOOKING AHEAD AT NEW TREATMENTS
health
INVISIBLE TUMOR, BUT ISSUES WITH IMPLANTS
It was great news: Pre-surgery chemotherapy had shrunk D’ Agostino’ s tumor to the point where it was no longer visible.“ I wanted a double mastectomy so my breasts would match, but the surgeon at St. Barnabas said that the non-affected breast takes longer to heal for some reason, and we should do them one at a time,” she says. In April, 2015, she had a single mastectomy and an expander inserted to slowly make room for the implant; in December, she had the same procedures performed on her right breast. Two months later, an“ exchange” surgery replaced the expanders with implants.
She was now deemed“ cancer free,” but over the next year and half, she would suffer repeated implant infections that required surgery to fix.“ The stitches would start opening, and they’ d have to either stitch it back up or replace one or both implants,” she says. In August, 2016, she was sitting on the beach at Cape May, when she saw that the skin over her left breast was gray. She drove straight to the emergency room at St. Barnabas Hospital in Livingston.
“ I had gotten off my anti-anxiety medications three months earlier, but now I was freaking out,” she says.“ I had so much fear that the cancer was going to come back.” A CAT scan showed nodules in her lungs, and a biopsy of her sternum revealed that triple negative breast cancer cells had traveled to her bones, too. Her doctors at St. Barnabas told her that in order to treat her stage 4 metastatic breast cancer, she needed to enter a
ACTIVE ADVOCATE D’ Agostino attendedan AssociationofAmerican CancerInstitute / CancerCenter Administrators Forum conference in 2017.
clinical trial, and suggested that she go to the Rutgers Cancer Institute of New Jersey( CINJ), a National Cancer Institute-designated research facility in New Brunswick.“ I was in shock,” she says.“ Now Iwas on my own.”
THE WORLD OF CLINICAL TRIALS
D’ Agostino conferred with doctors at hospitals in New Jersey and New York and found that an immunotherapy trial being conducted at CINJ held out the best hope for her.“ There are no guarantees with immunotherapy [ which harnesses the body’ s immune system to attack cancer cells ], but there are no guarantees with regular chemo, either,” she recalls thinking at the time. And there was another development: Her seventh infection related to her breast implants. This time, she told her new surgeon at CINJ that she wanted to have an“ explant” and“ go flat. He said that it was agood idea, given my history,” she says.“ He also said that if Ihad been under his care, he would have taken the implant out and given me months to heal before putting it back in.”
At CINJ, D’ Agostino received infusions of the immunotherapy drug Keytruda every three weeks for eight months.“ I had some nausea— though nothing compared to chemo— a little rash and some fatigue, and I didn’ t lose my hair,” she says. Once again, her cancer shrunk to the point where it couldn’ t be seen on CAT and bone scans.“ I never realized how much tension I was holding until I started a new treatment and got good news,” she says.“ Then, I could let my guard down, exhale and sleep for a week. That’ s when I realized how exhausting the whole process is.”
But six weeks later, her cancer started growing again, and she had to leave the trial, with no alternative but tofind anew one. Using the results of genomic tests to determine the type of tumor mutation she had, she sought advice from specialists at Memorial Sloan Kettering in New York and online resources such as SmartBridge Health, Driver. xyz and Share Cancer Support, and found another clinical trial being held at CINJ. This one called for her to have weekly chemo infusions, and to take a drug being tested for its ability to keep cancer cells from repairing themselves.
Once more, the combo was effective for about eight months, and then the markers for cancer in her blood started going up again. A PET scan and brain MRI showed two tumors in
LOOKING AHEAD AT NEW TREATMENTS
D’ Agostino’ s oncologist, Dr. Kevin Kalinsky, conducts clinical trials on potential breast cancer therapies for the National Cancer Institute.“ Triple negative breast cancer is acancer for which there is an unmet need,” he says.“ There are some interestingstudies that are about to be reported on that will lead to new indications of drugs beyond chemotherapy.”
For example, he says, immunotherapy has been approved for other cancers, including melanoma and lung cancer, but not breast cancer; a trial will determine whether that can change. Another exciting development is a smart drug that delivers high doses of chemotherapy directly to cancer cells.“ This antibody drug conjugate has breakthrough status, and we hope it will be approved in a couple of months,” he says.“ This is a paradigm shift.”
COURTESY OF CHIARA D’ AGOSTINO
42 FALL 2018 MONTCLAIR MAGAZINE