Verna’s Story

The Case of Verna – Estrogen Positive Breast Cancer Survivor

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Verna’s History

A few years ago, when Verna was 55, she noticed multiple lumps in both breasts.

She visited her doctor who arranged an ultrasound-based core needle biopsy, and shortly thereafter, Verna was told she had Breast Cancer: Grade 1, invasive and estrogen positive.

Based on the results of her ultrasound, the core needle biopsy, and her history of lumps in both of her breasts, Verna felt it would be important for her to have a double mastectomy and sentinel lymph node biopsy testing.

Her local oncologist had not provided Verna with a PET/CT as part of his initial diagnostic protocol. She reports that he told her, when she asked if a PET/CT would be helpful in her treatment, that her treatment team had all of the information they needed and therefore a PET/CT would not be helpful in her diagnosis and treatment.

Luckily, Verna didn’t quite feel right about that. So, just to be sure, Verna contacted us to get a second opinion before making such a life changing decision.

How We Helped Verna Using Our 5-Step System

1. Interim Support and Initial Personalized Research

We reviewed Verna’s medical records as well as any past, and currently prescribed, treatment protocols and began our review of the most current, relevant medical journals and research studies.

Based on Verna’s current lifestyle and work routine, there were two immediate changes Verna could make before her formal treatment had even begun: change her exercise and diet regimes.

Verna had a job that required many hours of sitting at a desk so her circulation wasn’t very good. Additionally, she had a very poor diet and was starting to suffer from the effects of type II diabetes.

Based on this data, we designed a cancer fighting diet for Verna, and we educated her on the benefits of a regular exercise regime. Certain forms of exercise are exceptionally helpful in slowing the growth of breast cancer as per current scientific data.

Verna also purchased a new desk (Varidesk) that would allow her to either stand up or sit while she works.

We also arranged for Verna to work with an independent community oncologist near her hometown who is supportive of precision oncology, and shares our philosophy of balancing government funded care and private medicine for optimal cancer care.

2. Advanced Diagnostics: More Options for Treatment

Genetic testing helps us identify any mutations for which medical science has already developed a targeted therapy drug.

Before she spoke with us, Verna didn’t know that there were many targeted therapy drugs for cancer showing excellent results in terms of life expectancy, with reduced side effects in contrast to standard chemotherapy.

Verna hadn’t understood how important getting genetic testing was until then! Without the data from genetic testing, Verna wouldn’t be able to gain access to those targeted treatment options that could help her. Verna had to prove that she carried the genetic mutation for which a specific drug was designed before she would be allowed to take it.

This makes sense, but also makes it hard to get the drug if you can’t get the test to show you need it. This is a shocking and frustrating position many patients face. But then they come to us, and we help them get the tests and data they need to be eligible for targeted treatment.

While our researchers continued to search for any new tests or treatments that might be helpful to Verna, we arranged for the genetic testing of a sample of Verna’s tumour tissue, to provide them with even more data to work with.

Additionally, we encouraged Verna to have a Positron Emission Tomography – Computed Tomography test otherwise, and understandably, known as a PET/CT test.

The Benefits of PET/CT

While most forms of imaging look at the density of the tumour and compare it to the surrounding tissues, PET/CT uses additional techniques to enhance the imaging data as a result. Below we’ve listed some significant benefits to PET/CT over other common imaging protocols like Ultrasound, MRI, CT Scan and X-Ray.

  • It is Minimally Invasive:

The PET/CT test requires you to ingest a harmless radioactive isotope that is bound to a sugar molecule.

  • Clearly Defines Cancerous Tissue:

Since tumour cells are constantly growing and therefore highly metabolic, they drink up more of the sugar-isotope solution than the surrounding tissues.

The amount of sugar-isotope solution that they absorb is referred to as the Serum Uptake Value (SUV) and assigns a numerical value to the agressiveness of the tumour based on how much of the solution it absorbs.

By absorbing the sugar-isotope any cancerous tumour will glow like a Christmas tree light; non-cancerous tissue is much less likely to be mistaken for malignant tissue with the PET/CT.

This is incredibly beneficial for the success of surgical procedures and for showing exactly where, and to what extent, the cancer is in your body.

In fact, we have had patients who have been told they had cancer, were scheduled for surgery to remove the tumour and to begin chemotherapy, decide to get a PET/CT just to be sure, and discover they didn’t even have cancer!

Conversely, it is very common for us to have patients who have been told their cancer is gone or that they don’t have cancer, only to pay for a PET/CT themselves and discover that they do in fact have cancer, and in some cases it was quite advanced. Had they not taken the initiative to get a PET/CT themselves they might not be here today.

  • Monitoring of Treatment Success:

PET/CT also shows, when used as a treatment-monitoring tool, how well a treatment is working for you so you can respond quickly to continue or change a treatment protocol.

Only live tumours will drink the sugar-isotope solution, so a PET/CT test can tell if a tumour is alive or if it has been affected (killed) by a specific treatment. No other form of imaging can reveal this essential information!

  • How Aggressive is Your Tumour/Which Ones To Target First?

Furthermore, since the amount of the sugar-isotope solution a specific tumour drinks depends on how fast it is growing, a PET/CT can determine how aggressive a specific tumour is compared with other tumours in the body. This can allow doctors to prioritize their focus surgically, and in treatment, on the tumours that are most likely to metastasize.

Our Client Care Coordinators arranged for Verna to get a private PET/CT scan at a local clinic and she had her test results within the week. We all had a much better idea of where the cancer was in her body and to what extent it had metastasized.

Some Good News for Verna!

For Verna, there was great news with her PET/CT results as amazingly, the PET/CT scan revealed ONLY ONE, SINGLE PRIMARY BREAST LESION with a minimal SUV max = 1.5, without evidence of axillary or distal FDG avid lymphadenopathy.

In other words, Verna had only a single, very small, and low grade cancer that could easily be removed with minimally invasive surgery.

Verna DID NOT REQUIRE THE DOUBLE MASTECTOMY she was planning to have as the remainder of the lumps in her breasts were harmless benign cysts!

Without the data she received from the PET/CT Verna would have had both breasts removed unnecessarily.

 3.  Interim Treatment Support

Verna had her tumour surgically removed and her sentinel lymph nodes were examined for disease.

Sentinel lymph nodes are the first few lymph nodes that the tumour drains into and are considered a diagnostic approach in determining if the tumour has spread beyond the primary site via the lymphatic system.

 4. Monitoring During Treatment

Verna’s sentinel lymph node biopsy results indicated that she may also have a case of small lymphocyte lymphoma (SLL). This is an indolent form of lymphoma that might never progress or progresses very slowly.

Further testing of her bone marrow showed “a light sprinkling of mature lymphocytes with no aggressive looking cancer cells.” In other words, there was no need to treat her lymphoma at that time.

Making Use of Verna’s Genetic Test Results

The results from Verna’s tumour DNA sequencing results showed that she had a PI3Kα – H1047R mutation.

This mutation causes a change in the amino acids at the 1047th codon of the gene from a histidine to an arginine. This is a common mutation in ER positive breast cancers and causes over-activation of the PI3K-alpha signalling pathway.

Studies have suggested that as a single driving mutation this mutation is associated with a positive prognosis in breast cancer patients.

Importantly, this mutation can sensitize breast tumours to targeted therapies including mTOR inhibitors such as everolimus, when combined with endocrine therapy. This is because endocrine therapy is known to activate the PI3K pathway.

After her surgery, Verna was given the option of adjuvant radiation therapy, which has been shown in certain cases to improve the overall outcome.

However, given the dual diagnosis of breast cancer and lymphoma, we felt that it was best to do a little more research on Verna’s genetics and treatment options to ensure this would be the best decision for Verna, as she was very opposed to radiation therapy.

To help Verna make the best choices for her, we did two things:

  1. Researched the Benefits of post-surgery radiation therapy (RT)

First, we researched the benefits of RT therapy given her tumour grade and found that the benefits of post-surgical radiation in lymph-node negative patients were specific to the surgical procedure the patients had endured.

One significant finding showed that in lymph node-negative patients, the survival advantage with RT is only observed in woman who had breast-conserving surgery (BCS), whereas the risk of death for post-surgical RT therapy after a mastectomy is increased.

This meant that while for others it could be just the opposite, there could be some benefit to post-surgical RT for Verna.

  1. Performed a Liquid ctDNA Blood-Based Biopsy Test

Secondly, given that Verna’s breast cancer cells were the only cells in her body that had this mutation, measuring the amount of this mutation in her blood using a new technique called Liquid Biopsy would give us an idea of the amount of cancer cells in her body.

So, in order to ensure that Verna was completely cancer free post-surgery, and that there was no immediate cause for concern, we performed a blood-based liquid biopsy to detect the amount of her specific PI3K mutation.

More Good News for Verna!

 The results of the ctDNA test came back negative, indicating that Verna had no detectable levels of cancer cells in her body.

Given these results, we concluded that standard external beam RT should be avoided due to cardiotoxicity, and that other RT-based therapies, such as brachytherapy and image-guided radiotherapy (IGRT), should be considered.

Brachytherapy uses small hair-like radioactive needles inserted around the site of the tumor and greatly reduces the amount of side effects and damage to surrounding tissues, such as the heart and lungs.

Another benefit of brachytherapy is that it can be followed up at a later date with external beam radiation. However, if Verna were to receive external beam RT first, she would not be a candidate for further RT protocols such as external beam or brachytherapy.

In regards to brachytherapy, we highly suggest the use of Isoray cesium 131 seeds, which provide a very high dose of radiation that only travels a very short distance, compared with other radiation isotopes.

Ultimately, Vera decided not to get post-surgery RT.

5. Clinical Trial Research and Advocacy

Recent advances in lymphoma treatment that target the PI3K-delta signalling pathway, rather than the alpha pathway altered in breast cancers, have resulted in significant benefits to patients without the harsh side effects of standard chemotherapy.

Since there are four unique PI3K signalling pathways (alpha, beta, delta, and gamma), we reviewed a series of pan-PI3K inhibitors (drugs that inhibit all PI3K pathways at the same time), and identified three drugs (GDC-0032, Copanlisib and AMG-511) that specifically inhibited only the PI3K signalling pathways (alpha and delta) that were driving the development of both her breast cancer and lymphoma.

In this way, Verna could potentially treat both of her cancers at the same time using a single drug should she need to have treatment in the future.

How is Verna Now?

Of most importance, Verna is currently still cancer free over 2 years after working with us.

To keep an eye on her cancer and give her greater peace of mind, Verna uses regular low-dose PET/CTs to ensure she is still cancer free.

Additionally, because of her genetic testing results, we know which mutations to look out for. This means that with a simple blood test anytime, Verna can see if her old cancer has returned. Verna will know if her cancer is back before it has time to become too advanced and, based on her genetic testing data, CTOAM has a list of targeted treatment options for Verna ready to go should that ever happen.

How Verna’s Case Can Help You

Since Verna was considering getting a double mastectomy prior to consulting with us, and the PET/CT we recommended showed that that was unnecessary, we were instrumental in helping her to keep both breasts! I think you’ll agree that that’s a pretty big deal.

Also, Verna didn’t need to undergo chemotherapy, but we have a list of options ready to go should she need to in the future.

Diet and exercise have huge benefits in treatment and in prevention of recurrence. Verna has embraced an active lifestyle and a healthy diet and has reaped the benefits of these changes – and her pre-diabetic condition has been reversed.

Remember, cancer is unique to every person. Your genetics and your lifestyle will create a unique combination of treatment options. Make sure you are doing all you can to beat Cancer.


Call our Cancer Care Team at (778) 999-5463 or email for a free initial consultation today.