Linda Collins (center) and her family –continued from page 11 mammogram were still clear. But I told him, ‘You say I’m okay, but I don’t feel okay. I need you to do something.’ So he finally ordered a scan.” The scan showed she had three masses in her chest, which were then biopsied. “It was breast cancer that had metastasized and spread,” Collins says. Her oncologist set her up with a treatment plan that consisted of the same kind of chemotherapy she’d had before. She was terrified to go through that again, but saw no options. Then her niece, a physician’s assistant, urged her to get a second opinion at City of Hope, where, the niece said, all sorts of new targeted therapies were being tried, some of which might not even require chemotherapy. Once under Yuan’s care at City of Hope, Collins learned that the treatment her prior oncologist had prescribed for her was based on a false assumption: that her metastasized cancer was the same type of cancer she’d originally been treated for, which is called ER positive. If he’d done the needed tests, Collins says, he’d have found that her new cancer was a different type, called triple-negative. It would not have responded at all to the treatment he proposed. But even had he done all the right tests 12 | ARROYO | 01.19 and treatments, he probably still wouldn’t have been able to do much for her. Triplenegative breast cancer is a less common form of the disease, and there’s been little success treating it, says Yuan. “The prognosis is 12 to 18 months,” she notes. We asked Yuan how she decided to create Collins’ clinical trial. “Breast cancer is such a common disease and affects so many people’s lives,” Yuan says. “Early stage breast cancer, thanks to all the previous research and medicines, is largely curable and treatable. But every day we face folks who come to us with so-called metastatic or noncurable disease. It has metastasized to elsewhere and creates a limited life span. So that’s where our passion is. We want to bring more novel treatment to help these women and one day cure them, just as nowadays we’re curing lymphoma and leukemia. But so far, we haven’t cured a lot of solid tumors.” Is metastatic breast cancer considered a solid tumor? “Yes, it can be melanoma, lung, brain, colon or other kinds of cancer. With metastatic cancer, the cancer is there, but it’s probably microscopic disease that we can’t diagnose” until it shows up as a solid tumor, Yuan says. In Collins’ case, she explains, extensive testing revealed not only the bad news — that her patient was triplenegative for all three hormone receptors and therefore not a candidate for targeted therapy — but also a smidgen of possible good news: Collins tested positive for androgen receptors, which are cells that respond to the male hormone. There is a drug for prostate cancer in men that targets androgen, Yuan explains. That drug had already been tried in studies of triple-negative breast cancer patients like Collins, but with limited success. Yuan wanted to try it again, this time combined with state-of-the-art immunotherapy drugs that boost the patient’s immune system and had recently become available. “I applied to Merck, which got FDA approval for Keytruda in 2016, and we got Merck to sponsor this study which combines an androgen-receptor modulator with new immunotherapy.” Collins was enrolled in the trial, along with a number of –continued on page 14 PHOTO: Courtesy of City of Hope
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