Published on May 7, 2021
Putting Family First After a Metastatic Breast Cancer Diagnosis
Liz Satterfield received a breast cancer diagnosis in the midst of planning her wedding and starting her family. In 2016, her breast cancer returned, and it had metastasized. Watch to learn how Liz prioritized family and continued to live a full life in the face of a metastatic HER2-positive breast cancer. Dr. Hannah M. Linden, MD, of Seattle Cancer Care Alliance also joins to discuss the specifics of different breast cancer diagnoses and the treatments that are in development to combat this cancer.
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Transcript | A Metastatic Breast Cancer Journey: Family First
Liz Satterfield: In 2014, February 10th, I was diagnosed with early-stage breast cancer, which wasn't entirely shocking given my family history, but was rather shocking that I was as young as I was and was actively getting screened for breast cancer. My diagnosis at the time was stage two, ER-positive, PR-positive, HER2-negative inflammatory breast cancer.
Liz and her partner cancelled their plans for a large wedding in Wisconsin and drove to Minneapolis where they got married at the courthouse the day before Liz started chemo.
When Were You Diagnosed With Metastatic Breast Cancer?
Liz Satterfield: In 2016, my wife and I had made plans to move back to Seattle. She's from the Seattle area, and we had always had the intention of getting back to Seattle in three to five years. And as we were working on my transfer of care with my clinical team in Milwaukee, we were doing some scans and we found that my cancer had gone metastatic.
Dr. Linden: You know the definition of cancer, unfortunately, is that the cells know how to live on their own. They're not confined to the organ. So, a common question we get is, well, if it's in my liver, isn't it liver cancer? And no, it's cancer that started in the breast, but escaped. So, when we treat people with curative intent, we try to reduce the chance that that escape happens, by giving therapies to the whole body to reduce the chance that the cancer is going to pop up elsewhere.
But sometimes it does, and I don't think we fully understand exactly why, but there are quiescent states that cells can hide in, probably in the bone and bone marrow. Cancers seem to pop up in the lymph nodes around the breast, right at the edge of the radiation field. So, there are areas that we know are at risk, but we don't fully understand this. And we don't fully understand exactly when tumors are going to pop up either.
The Importance of Persevering and Putting Family First
Liz Satterfield: We didn't want to lose the opportunity to have a family because of this diagnosis. And we made the decision to move forward. And in January of 2018, we brought our daughter, Rowan, into the world. I had gone through multiple lines of treatment to get to that point. There were times that I hoped I'd make it, not that I was that sick, but just that nervous and scared that I'd make it to meet my daughter, that I would be able to see Heather have our child.
A week before my daughter's due date, we found out that the mets had spread to my brain, and that I needed gamma knife radiation. So, within a couple of days, I was getting gamma knife radiation to multiple mets in my brain and praying that my wife didn't go into labor while I was in the machine or incapacitated.
I actually went back to work at my request for a week because I had spent my career in the same industry, healthcare technology and software, and the big annual show for our industry was about to happen. And I wanted to go see all of my colleagues that I knew that would be at the show that I had met over the years, because I was pretty sure I wasn't going to make it another year. I didn't know why; it was just a feeling I had.
And man, my intuition was spot on, because the day we got back from that I had some scans that turned into a biopsy on my liver, and that confirmed that my cancer had mutated from HER2-negative to HER2-positive. Which explains why it was so excited to travel to the brain and why I was dealing with such a brain mets challenge. So that was a huge change, and that was when I made the decision that I needed to stop working. And I loved, loved my job. I miss my job.
Dr. Linden: It's actually infrequent that the tumor changes it stripes, probably on the order of 15% of the time, but it certainly happens. We've seen it. It may be more common than we think.
It's also possible that the tumor can sort of de-differentiate, change its stripes, along the way while you're treating it, and I've seen that. It's not standard of care to do more than one metastatic biopsy, but it isn't wrong either. So, we do do them because we're looking for targets to treat. And HER2 is a robust target to treat.
Liz Satterfield: So last summer I was able to avoid the whole-brain radiation, which was amazing, but we had to start really watching this tumor. So, we fluctuated between brain MRIs every one to three months until most recently, just really watching this tumor.
And it scared me because the viable options were the craniotomy, a brain surgery, whole-brain radiation, which would only address that one issue, not the other small spots in my brain. So, it could have been both. And then I started taking this new combination of tucatinib (Tukysa) and capecitabine (Xeloda) and Herceptin (trastuzumab) and very quickly saw positive results, and the “hail mary” worked.
How Have Treatment Options for Breast Cancer Patients Improved?
Dr. Linden: I've been doing this for a while, and one of the more rewarding things is that we just keep developing better and better treatments. I've been able to participate in some of that, and it is so exciting to be able to offer better treatments to patients.
I think we're getting much better at finding the right treatment for each patient. And we're getting much better at controlling the disease and buying patients a longer period of quality time.
I know that recently we've been talking at national meetings about, “Can we cure stage four breast cancer?” And it's in the HER2-positive patients that we're particularly excited about that, because we have so many better tools now.
Trastuzumab was a huge game-changer for us, but there are now many other drugs that target HER2. I think trastuzumab is still the mainstay of treatment, but in the last year there've been, I think, three FDA-approved new drugs.
Tucatinib, margetuximab (Margenza), and [trastuzumab] deruxtecan (Enhertu) have all been approved and are active. So, this is really exciting for patients because I think we can control their disease in a much more humane fashion. These are targeted agents that don't have horrible side effects, and so you can live with the disease under much better control.
Liz Satterfield: I'm happy to report I'm still feeling great. And right now, I'm just waiting to see what the next scans are going to show. And sticking with this treatment because it's currently working and I'm just hopeful that it'll continue to work for quite some time, because ironically, with everything that I just described in the last year, this is without question the best I have physically felt in the last five years, possibly the last seven.