Treatment History

Here is a summary of Lou’s treatment history and tumour/blood molecular screening results + access (by request) to her reports. If you think you can offer any value in any way, please do not hesitate to ask.

  1. Diagnosis date: June 2017, 39 years of age – Stage IIA (cT2N0) triple negative invasive ductal carcinoma of the left breast. 22mm. Ki67 60%
  2. Chemo: Started 12 July 2017 – Neo-adjuvant chemotherapy
    1. Three rounds of FEC and three rounds of D (12Jul17 – 24Oct17)
      1. From my memory, the tumour shrunk slightly in the first three rounds but then grew in the next three rounds….
      2. One round (4th) had Carboplatin in it (whilst awaiting results of BRCA testing)
        1. Note: No mutation was detected in ATM, BRCA1, BRCA2, PALB2 or TP53
      3. She had an unplanned admission to hospital with febrile neutropenia after C4
  3. Breast surgery: Left skin-sparing mastectomy and sentinel lymph node biopsy on 22 November 2017 – (Prof Andrew Spillane).
    1. Tumour report: RCB-III response to treatment with residual 23x20mm grade 3 triple negative invasive ductal carcinoma. No evidence of treatment effect. 1/9 lymph nodes involved with 2.25mm macrometastasis. No ENE or LVI.
  4. Radiotherapy: Mid January- 22Feb18: 24 rounds (Dr Marita Morgia)
  5. Oral Chemo: Six rounds of Xeloda (capecitabine) (eight were planned) + Zoladex (goserelin) for ovarian suppression
  6. Pain in the ribs (for about six weeks) was the catalyst for scans
    1. Abdo USS 30Jul18
    2. CT chest/abdo/pelvis 31Jul18
    3. whole body bone scan and Liver MRI 03Aug18
      1. i. Bone Scan
      2. ii. Liver MRI
  7. The result from scans is metastasis in liver and right ninth rib
  8. Biopsy – Samples taken from Lou’s ninth rib for the Immunotherapy Trial and the MoST trial 13Aug18
  9. Radiotherapy on ribs; Five sessions 13-20 Aug18
  10. Immunotherapy Trial; JAVELIN Medley,  avelumab +utomilumab, starting 5 Sep – (Dr Rick Kefford) 
  11. RGCC Results 5 September (Katrina Ellis): Possible personal treatment options include:
    1. The specific tumour appears to have resisting populations because of the MRP overexpression that can be reversed by the use of inhibitors of ABCG2 pumps.
    2. The neoplasmatic cells have the greatest sensitivity, in the nucleous spindle stabilizer (Abraxane), in the tubulin dimmer polymerization inhibitors (Vinorelbine, Ixabepilone ), in the antagonist (Gemcitabine)
    3. Also can be used Everolimus/Temsirolimus as an inhibitor of Akt/mTOR pathway, Afatinib as an inhibitor of EGF r and HER-2.
    4. Radiotherapy/ Hyperthermia sensitivity
  12. MoST Results 19 September 2018
    1. TMB is 9, this is “low average.” This means IO might not be as effective as someone with a high TMB.  “Some low TMB patients still respond though.”
    2.  AKT2 protein is amplified. “Mtor” Inhibitors can help with this by blocking this signal
    3. “FBXW7” is defective/ there is a mutation in the cell cycle. Cell cycle checkpoint inhibitors could target the checkpoints
    4. TP53 is defective but doesn’t have a treatment at this stage
    • The above treatments from the MoST data “are experimental, the chances of them working are low.”
  13. Foundation One 
    1. FBXW7 encodes the F-box protein subunit of the SCF ubiquitin ligase complex, which targets proteins for degradation1. FBXW7 inactivation is associated with chromosomal instability and with stabilization of proto-oncogenes, such as mTOR, MYC, cyclin E, NOTCH, and JUN; FBXW7 is therefore considered a tumour suppressor1,2.
    2. Treatment:  Everolimus or Temsirolimus
  14. Pulled from the IO/PARP trial because it’s not working. Scan results show enlarged para-aortic lymph node at the level of the aortic bifurcation which measures 12mm in short axis. The primary tumour has doubled in size and there are numerous further metastases scattered throughout the right lobe of the liver. There are also small lesions in the left lobe. The partially lytic and sclerotic lesion in the right 9th rib appears slightly more extensive.
    1. Starting Gemcitabine and Carboplatin on 22 October. One week of gem-carbo, followed by a week of gem and then a fortnight off. repeat. 
      1. Day four post initial treatment; febrile neutropenia and platelets etc through the floor = Hospitalisation. The second round of chemo has been delayed twice, now scheduled  14 November. We discontinued this chemo regime. 
  15. OncoDEEP
    1. Potential Clinical Benefits:  doxorubicin hydrochloride, epirubicin hydrochloride, Everolimus (mTOR), Metformin, Sirolimus, temsirolimus (mTOR)
  16. TACE with Professor Vogl 
    1. Half of the liver (R) on 16 November (MRI done before and after surgery)
    2. The other half has been postponed until early December due to poor health (MRI 22 November)
      1. 9.88mg mitomycin, 101,18 mg irinotecan, 50,2mg cisplatin, 5 ml Lipiodol occlusion, 180 mg EmboCept. Other: 3mg Granisetron, 20mg Dexacortin, 100mg Pethidine
  17. Treatment with Arnhold and Slebenhuner*
    1. Curcumin, Shogal and Resveratrol Infusions
    2. Photodynamic Therapy
    3. Regional Hyperthermia
    4. IPT (Insulin Potentiation Therapy)
      1. *We were not able to continue with all of the above-intended treatments. Lou’s liver is not healthy enough. We have only been doing a reduced amount of infusions to aid recovery. GERMAN SCHEDULE HERE
  18. Unplanned hospital admission Pleural effusion 27 November – Thoracentesis, 1.5 Litres removed (Vogle)
  19. Pleural effusion 4 December – Thoracentesis, 1.5 Litres removed (Vogl)
  20. Pleural effusion 13 December – Thoracentesis, 1.7 Litres removed (Vogl)
  21. TACE with Professor Vogl 
    1. Second Half of the liver (L) on 14 December (MRI before, CT after)
    2. 9.88mg of Mitomycin C, 101,96mg Irinotecan, 50,12mg Cisplatin, 5ml Lipiodol and 180mg EmboCept
  22. Self-admitted to Medias Clinic: 19th – 24th December; Unmanageable pain, Nausea, Hadn’t eaten for 4 days, dehydrated, delirious, blood’s dropping uncertain about pleural effusion  – Needed 24-hour care 
    1. IV fluid, food, potassium
    2. Blood transfusions
  23. Pleural effusion 26 December – Thoracentesis, 1.2 Litres removed (Herzog)
  24. Self-admission to Prof Herzog’s clinic for 24-hour care
    1. Oxygen Therapy, Local Hyperthermia, Ozone Infusion, Ozone Intramuscular Injection, Magnetic Field Therapy, Massage, Infusions, Physio
  25. Pleural effusion 31 December – Thoracentesis, 1.5 Litres removed (Herzog)


For access to Louise’s reports –
Request Here