February 28, 2019
Triple-negative breast cancer survivor sees only benefits from immunotherapy clinical trial
BY Cynthia DeMarco
Lori Shults didn’t know much about clinical trials when she first came to MD Anderson in May 2017. “I thought they involved some people getting medicine and others just getting sugar pills,” she recalls. “That sounded too risky for me, so I wasn’t interested.”
Fortunately, the Hill Country school teacher soon learned that her understanding of clinical trials was both limited and inaccurate. She also learned that an innovative clinical trial being conducted as part of MD Anderson’s Breast Cancer Moon Shot™ could benefit her personally.
The trial would allow Lori to start her treatment with chemotherapy (the standard for triple-negative breast cancer) and pursue other options only if that proved ineffective.
“Once I realized I’d be getting what everyone else got, plus something extra if the conventional treatment didn’t work, I didn’t see a downside to it,” she says.
A team approach with individualized care
Lori was diagnosed with triple-negative breast cancer at age 38, after finding a lump in her right breast. She went to a local surgeon recommended by her gynecologist, but their miscommunications left her feeling even more anxious about her situation.
“The surgeon said I needed to have my breast removed right away,” says Lori, who decided then to come to MD Anderson. “But I don’t like being rushed. I also don’t like having to tell my whole story over again to every new doctor I meet. Not having everyone all together made it feel really chaotic.”
At MD Anderson, Lori met with her entire care team on the same day. They agreed that her treatment should start quickly. “But there wasn’t the same frantic sense of urgency,” Lori recalls. “I had time to breathe and ask questions.”
Lori needed to begin chemotherapy just as the school year was ending. Her oncologist made special accommodations to ensure she could still go on a much-anticipated summer vacation.
“It takes about a week to get a port installed to receive chemo infusions, and I didn’t want to miss out on my river trip, so my doctors let me receive my first infusion through a PIC line instead,” she says. “Knowing I didn’t have to put the rest of my life on hold for cancer meant the world to me.”
Choosing an immunotherapy clinical trial
Unfortunately, the standard chemotherapy cocktail of doxorubicin and cyclophosphamide was not as effective at shrinking Lori’s cancer before surgery as her doctors had hoped it would be. So, as part of the Moon Shot clinical trial, they analyzed her tumor and discovered she might benefit from a related immunotherapy trial.
That immunotherapy trial was also led by MD Anderson’s Breast Cancer Moon Shot team, which is driven to discover more effective, personalized treatment strategies that lead to more cures for triple-negative breast cancer. The Breast Cancer Moon Shot is part of MD Anderson’s Moon Shots Program, a collaborative effort to rapidly transform scientific discoveries into clinical advances that save patients’ lives.
Lori followed her doctors’ advice and switched to the immunotherapy clinical trial. She began receiving a new combination of drugs — the chemotherapy drug nab-paclitaxel and an immunotherapy drug called atezolizumab — in August 2017. As a part of the trial, Lori would get an IV infusion of the drugs once a week for four months, then have a mastectomy to remove the tumor. She would also receive the drugs for three months afterwards.
Fortunately, Lori’s cancer proved responsive to the new drug combination. “By the time the tumor was removed, it was all dead cells,” Lori says. “The cancer had been killed.”
Immediate vs. delayed reconstruction
Lori’s nipple-sparing mastectomy took place on Dec. 1, 2017, under Rosa Hwang, M.D. To minimize the amount of time she spent in recovery, Lori also had immediate reconstruction of her right breast under Mark Villa, M.D. He installed a permanent implant during the same procedure.
“I could have opted for a tissue expander instead,” Lori says. “But then I would’ve needed another surgery later on to take it out and replace it. I didn’t want to go through that twice if I could avoid it.”
Helping other women through clinical trial participation
Lori finished her treatments on Feb. 21, 2018, and she continues to show no evidence of disease today. And while she is grateful to be cancer-free, she’s also excited about the prospect of helping other women through her clinical trial participation.
“I looked at my friend’s 7-year-old twin daughters and thought, ‘If, God forbid, this should ever affect them someday, and I could make just one of their lives a little easier …,’” Lori says. “That was one of the main reasons I did this.”
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I didn’t see a downside to it.