Doni Schaefer isn’t your typical breast cancer patient. When her cancer was detected in the summer of 2015, it was neither early stage, nor the kind that responds well to standardized chemotherapy regimens. Hers was a fast-growing aggressive subtype known as HER2. The unfavorable biomarker, found in 15 to 20 percent of breast cancers, signals a more complex condition to treat.
That year “was such a blur of medications and treatments, I didn’t have time to dwell on the complexity of my cancer,” said Schaefer, whose whirlwind medical journey began after she felt a marble size lump in her right breast.
“Fortunately, my doctors and everyone around me were really positive. All I had to do was focus on staying strong and have faith that it all was going to work.”
Thanks to advances in genomic research and testing, Schaefer and others like her represent a new face of breast-cancer survivorship. Now, two years after her diagnosis, the Myakka Valley Ranches woman is a smiling testament to the success that genetic profiling and personalized therapies are having in the treatment of more aggressive breast cancers.
Schaefer’s case is an important reminder that there is no one-size-fits-all when it comes to treating breast cancer — and that survival no longer hinges on the blanket trial-and-error approach of older treatment regimens.
Although breast cancer is often discussed as a general condition, there are several different types, and each responds differently to different treatments, said Dr. Scott Lunin, a medical oncologist with Florida Cancer Specialists in Sarasota who guided Schaefer’s treatment.
“With today’s knowledge and technology,” he said, “we can look deep into the biology of a patient’s malignancy and make treatment decisions based on their genetic make-up and specific cancer subtype.”
Genomic testing allows researchers and specialists to study cancer patients’ DNA for genetic clues to explain what has been altered and what is fueling an individual’s cancer. Results from such testing are key determinants in what treatments offer the best outcomes for a particular disease.
As part of Sarasota Memorial’s cancer care team, Dr. Lunin took Schaefer’s case to the hospital’s Breast Cancer Tumor Board, a multidisciplinary group of medical oncologists, radiation oncologists, breast cancer and reconstruction surgeons, radiologists and pathologists who meet regularly to evaluate complex and challenging cancers, discuss optimal treatments, the latest research and clinical trials, and ensure patients receive the least invasive and best therapies available.
Schaefer’s oncology team had a number of challenges to address. Her tumor, slightly less than 2 centimeters, was located on her chest wall, which made surgical removal more challenging. It was Stage 2-3 and had already spread to at least two lymph nodes. And, it had high levels of HER2 (human epidermal growth factor receptor 2), a protein involved in cell growth, differentiation and blood vessel formation that makes the cancer more aggressive.
In the past, tumors with an overexpression of HER2 were associated with an increased risk of both recurrence and death. But the very biomarkers that make it unique also make it treatable with a targeted approach. Schaefer’s team recommended chemotherapy along with the antibody-based therapy trastuzumab (Herceptin) to shrink the tumor before surgery and disrupt the cancer cells’ growth.
Her treatment also included a second drug, pertuzumab (Perjeta). When added to chemotherapy, the two HER2-targeted therapies reduce the risk that cancer cells will return or spread to other parts of the body. Schaefer underwent the targeted treatments and chemo-therapy once a week for 18 weeks. A double mastectomy followed, as did 23 radiation treatments to further reduce the risk of recurrence. She completed her treatment plan with reconstructive surgery in September 2016.
It was a grueling year for the wife of a pilot and mother of three who managed a busy household, including homeschooling a middle-schooler and supporting a teenage daughter in high school and a son just finishing college. While family and friends helped tend to the horses, dogs and ranch house chores, Schaefer did her best to keep up with BMX races, horse shows and school lessons through seemingly endless side effects—fatigue, nausea, hair loss, pain, numbness, loss of appetite.
But as the year came to a close, Schaefer said she had much to be grateful for. Blood tests and scans revealed no evidence of cancer, and through genetic testing, she found that her cancer was not hereditary.
“I don’t know why I got breast cancer,” Schaefer said, “but I’m very thankful for my amazing doctors and all the new friends I’ve met along the way — so many wonderful women who battled or are still battling the disease. I hope sharing my story helps in some way.”