Stage 4 Triple-Negative Breast Cancer: The Right Treatment May Be At Hand.
From the blog of Dr. Robert A. Nagourney, MD:
Some may remember a blog I posted on August 2, 2019 regarding a woman in Orem Utah diagnosed with triple-negative breast cancer. She consulted with a famous medical center where they recommended a treatment widely used for breast cancer, but not necessarily the best one for triple negative. The patient decided to travel to California for a biopsy that identified a completely different treatment to be right for her.
Her doctors insisted that she receive Cytoxan plus Adriamycin followed by Taxol (AC-T) yet her laboratory analysis could not have been more negative for that combination. Bravely, she traveled to California to receive 6 cycles of our recommended therapy, which provided a complete remission and she is now alive and free-of-disease 5 years later.
Not surprisingly, she became an advocate for our laboratory-based approach and her story was featured in USA Today on October 25, 2019.
When a 41-year-old mother of 3 who resides in Utah realized that the treatment she was receiving for her own triple-negative breast cancer was not working she contacted my patient for advice. Having already received 3 cycles of chemotherapy she could feel her tumor growing. When an MRI confirmed disease progression the patient became alarmed. This is where the story gets odd.
Her medical oncologist, given evidence of disease progression, suggested that this could represent “pseudo-progression” a relatively rare phenomenon that occurs when immune therapies induce lymphocyte infiltration that causes cancers to falsely appear to grow. Based on this assumption, he recommended continuing the same treatment.
Concerned that the oncologists ’optimistic explanation for her growing cancer might be wrong, she traveled to our office where our breast center conducted a biopsy. This provided ample living cancer cells, confirming the patient's worst suspicions and the lab analysis revealed that the treatments she was receiving were not active.
With gross residual disease after 3 cycles of therapy, I felt confident that her treating oncologist would apply our recommendations. After all the combination we recommended is established in the published literature and better tolerated than the one she was currently failing.
Instead, the physician put his foot down and said he would not use the recommended treatment. I was dumbfounded. Why would this physician insist upon treatments that did not work when there were treatments that would? Why would this physician insist on continuing a combination that was manifestly ineffective and force the patient to suffer toxicity without benefit?
The patient and I had a lengthy discussion. I explained that she could not afford to continue the current therapy as she was obviously progressing as confirmed by the abundance of living cancer cells in our biopsy. No patient with 3 cycles of aggressive chemotherapy under their belt should have gross residual disease in the breast.
We needed to make a decision. If she was to save her life, she would need to leave the care of that physician. Whether I or someone else assumed her care, she needed to take the treatment that worked for her. Period.
This is just one of many examples of patients who need to take charge of their own disease. I would gladly have worked with the patient’s doctor and offered to provide doses and schedules that we had so successfully applied in this setting.
I provided the patient with several of our published studies that I had written over the years establishing the benefit of what we were recommending. That having been said, saving this patient’s life is the most important mission, and we will proceed with our treatment, regardless of what her physicians say or do.