Battling Stage 4 HER2-Positive Breast Cancer
- A 53-year-old grandmother beat HER2-positive breast cancer after initially being told her stage four diagnosis would leave her with just two years to leave. Now she’d sharing her story to offer others hope and know that other treatment options do exist.
- Although Willits is crediting immunotherapy for saving her life and the type of treatment has generated significant breakthroughs in the treating several cancers, it has not yet been widely effective in breast cancer and it is not a standard of care. Clinical trials across the country have been looking at how to make breast cancer more susceptible to immunotherapy.
- 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. While there is technically no cure, many advancements in treatments exist to improve patient outcomes, which is something to be hopeful about.
- In breast cancer that has spread to the bone, the cancer is often hormone receptor-positive, according to SurvivorNet experts. In most instances of hormone receptor-positive metastatic breast cancer spreading to the bone, the first line of attack is hormone therapy.
- The human epidermal growth factor receptor 2 (HER2) is a receptor on the surface of almost all the cells in our body, and it is one of the many receptors responsible for the communication between the cells to promote their growth, division, repair, and survival.
- In immunotherapy treatment, the immune system uses its white blood cells to attack cells in the body that are abnormal or foreign.
The breast cancer survivor shared her story with Fox News Digital during a recent interview, where she recounted receiving her metastatic breast cancer diagnosis in March 2022, saying, “I still remember the doctor coming in and telling us that it was in my lymph nodes, ribs, spine, sternum and bones.”
Read MoreWillits started on chemotherapy before finding a doctor at The Williams Cancer Institute in California who insisted he could “cure” her,
Then, six weeks after undergoing immunotherapy treatments, along with a minimally invasive procedure called cryoablation to destroy cancerous cells by freezing them and taking supplements, a followup PET scan showed Willits to be cancer-free.
Expert Resources On HER2 Breast Cancer
- A ‘New’ Type Of Breast Cancer? Practice-Changing Results? New Study Says Yes, And Provides Hope For Patients With HER2 ‘Low’ Breast Cancer
- Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
- Exciting New Option For HR+, HER2- Breast Cancer Recurrence: With the Approval of Truqap, More Women Can Be Treated With Targeted Therapy
- HER2-Low, A New Classification Of Breast Cancer, Expands The Use Of Enhertu For Metastatic Patients
- Treatment for HER2-Positive Breast Cancer
- When to Order Immunohistochemistry Testing: With Tailored Therapies for HER2-Positive Cancers, IHC is More Relevant for More Patients
She told Fox News Digital, “Cancer, we feel, is completely behind us … and that was almost an impossible mission. People ask me all the time, you know, how did you cure your cancer? And I say, ‘Well, God led me to Dr. Williams [Dr. Jason R. Williams of The Williams Cancer Institute in California].'”
Is Immunotherapy Effective in Treating Breast Cancer?
Willits hopes her story will help other women understand that other treatment options are available, adding, “The reality is there are women out there who don’t know it exists. And if we can get the word out, I can’t even tell you how many hundreds of women we could potentially save.
I cannot even imagine if I had stayed the course of traditional treatment and just tried to stop the progression. I mean, it’s out of my body. It’s gone. Life is back to normal again. And I am so grateful.”
What is ‘HER2-positive’ breast cancer?
The human epidermal growth factor receptor 2 (HER2) is a receptor on the surface of almost all the cells in our body, and it is one of the many receptors responsible for the communication between the cells to promote their growth, division, repair, and survival.
In other words, HER2 is one of the many receptors that help cells grow and divide when the timing is right.
Living With HER2-Positive Breast Cancer
All breast cells are examined for an abundance of this protein (HER2). HER2 proteins act as receptors that regulate the growth and division of cells. If there is an excess of HER2 receptors in breast tissue (known as overexpression), it can lead to rapid multiplication of breast cells. This uncontrolled growth may result in the formation of a tumor.
Breast cancer classified as HER2-positive tends to exhibit faster growth, increased likelihood of spreading (metastasis), and a higher chance of recurrence. Despite its aggressive nature, HER2-positive cancer responds well to treatments that specifically target HER2 proteins.
There are no distinct symptoms or specific risk factors associated with HER2-positive breast cancer, although research indicates that this type of cancer may be more prevalent among younger women.
As for metastatic breast cancer, which is also called “stage four” breast cancer and the stage of cancer Willits was diagnosed with, this 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.
Understanding treatment options for HER2-positive and metastatic breast cancer
The treatment approach for breast cancer varies greatly depending on your individual disease. Top oncologists have previously explained to us the different treatment options and why a personalized, tailored approach is so important.
Treatment for HER2-Positive breast cancer may include the following approaches (or a combination of several):
- Surgery
- Chemotherapy
- Radiation
- Targeted drugs
Treating advanced HER2-positive breast cancer
Meanwhile, treatment for metastatic breast cancer may involve:
- Hormone therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
- Surgery
- Radiation
Additionally, if the first attempts at therapy do not work, or stop working, there are other options for women with metastatic HR+ cancer.
These include:
- Alpelisib (Piqray) — A PI3K inhibitor (for PIK3CA activating mutation)
- Elacestrant (Orserdu) – An estrogen receptor blocker (for ESR1 mutated receptors)
- Olaparib (Lynparza) – A PARP inhibitor (for BRCA1/2 mutated breast cancers)
- Capivasertib (Truqap) — An AKT inhibitor
- Fam-trastuzumab deruxtecan-nxki (ENHERTU) – An antibody drug conjugate
- Sacituzumab govitecan (Trodelvy) — An antibody drug conjugate
- Pembrolizumab (Keytruda) – PD-L1 immunotherapy, for patients with high tumor mutational burden
Trodelvy was recently approved by the Food and Drug Administration (FDA) for patients with HR+, HER2- metastatic breast cancer that had stopped responding to at least two earlier courses of therapy.
Drug therapies in the setting of metastatic breast cancer are constantly changing as new drugs and drug combinations are introduced. As a result, there are a plethora of treatment options, especially for those who progress or cannot tolerate a specific treatment.
Cancer treatment is becoming more personalized thanks to next generation sequencing. Please speak to your oncologist about which options are right for you.
Immunotherapy and Breast Cancer
While there are many immunotherapy options, Keytruda is revolutionizing the cancer treatment world as it is gaining more and more U.S. Food and Drug Administration approvals to treat various types of cancers.
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.
The first women to be cured with immunotherapy for metastatic breast cancer is Judy Perkins, who was diagnosed with early-stage ductal carcinoma in situ, or DCIS, breast cancer in 2003. (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.)
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.”
Understanding How Immunotherapy Works
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: SurvivorNet Staff
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