Clinical trial offers triple-negative breast cancer patients tailor-made treatments if chemotherapy fails

Growing up, Lori Shults had no idea she shared a hometown with the man whose work would one day save her life.

Shults was born in Alice, Texas — the same small town where Nobel Prize-winning immunologist Jim Allison, Ph.D., grew up. Allison, MD Anderson’s chair of Immunology, pioneered checkpoint blockade immunotherapy, which frees the immune system to attack cancer. His research led to the 2018 Nobel Prize in Physiology or Medicine.

Without immunotherapy, it’s possible Shults wouldn’t be alive today.

A scary breast cancer diagnosis

In April 2017, a then-38-year-old Shults noticed a lump in her breast, which she had checked out by her gynecologist. Without much concern, her doctor recommended a mammogram.

“I could tell from the mammogram tech’s demeanor that things weren’t good,” Shults says. “When they sent the radiologist in to talk to me, I thought, ‘Uh oh.’”

After a biopsy, doctors confirmed Lori had stage II triple-negative breast cancer, an aggressive form of the disease that doesn’t rely on the hormones estrogen and progesterone or the protein HER2, which fuel the growth of most breast cancers.

“Triple-negative sounds horrible. The name itself. So it’s pretty scary to hear those words,” says Shults, a teacher in the Central Texas town of Geronimo.

Moon Shot momentum propels breast cancer clinical trial

Unsatisfied with her local oncologist’s treatment plans, she went to MD Anderson and met with Stacy Moulder, M.D., professor of Breast Medical Oncology and co-leader of MD Anderson’s Breast Cancer Moon Shot™.

“After I talked with Dr. Moulder, I felt a lot better,” Shults says. “She explained what triple-negative meant — that it was not responsive to those hormones. It made me feel more relieved to understand what the disease involved.”

Moulder also explained that triple-negative is not a single disease, but rather a catch-all term for any breast cancers missing those receptors.

Through the Moon Shot™, MD Anderson clinicians and researchers are working together to discover more effective treatment strategies, guided by each patient’s tumor, that lead to cures for more patients.

The Breast Cancer Moon Shot is part of MD Anderson’s Moon Shots Program™, a collaborative effort to accelerate the pace at which scientific discoveries are translated into clinical advances that save patient’s lives.

Standard care for early-stage triple-negative breast cancer is a pre-surgical chemotherapy combination of doxorubicin and cyclophosphamide, known as AC. In 35 to 40 percent of patients, this results in a complete response.

Personalized breast cancer treatment

“Unfortunately, over half of patients will not respond to chemotherapy,” Moulder says. “We want to understand why some tumors are sensitive to chemotherapy, and we need to identify effective targeted therapies for the rest of our patients.”

To do that, Moulder leads an innovative Moon Shot trial called ARTEMIS.

When enrolling in ARTEMIS, patients undergo a biopsy and begin standard chemotherapy. While they’re being treated, the Moon Shot team works with the Cancer Genomics Laboratory and APOLLO, both Moon Shots research platforms, to perform detailed analyses of the tumors.

If ultrasound imaging shows a tumor has responded, the patient continues with chemotherapy until their surgery. Then, researchers are able to study the tumor and learn why it responded.

If chemotherapy doesn’t seem to work, the patient is offered the opportunity to participate in one of several other clinical trials linked to ARTEMIS, based on their tumor’s unique characteristics.

Saving breast cancer patients from unnecessary treatment

“With ARTEMIS, our patients don’t have to wait for molecular profiling results to start treatment,” Moulder says. “We can start their therapy, and by the time we need to make a decision about next steps, we have the information we need. And patients that respond aren’t subjected to any unnecessary targeted therapies.”

When offered the chance to participate in the trial, Shults didn’t hesitate.

“The way it was explained, it sounded like you couldn’t go wrong,” she says. “That made me feel much more relieved, that I would get the standard of care. And if that didn’t work, the treatment would be something more targeted to my needs.”

She proceeded under the care of David Ramirez, M.D., assistant professor of Breast Medical Oncology. Unfortunately, after four cycles of chemotherapy, Lori’s tumor hadn’t responded.

Responding to immunotherapy

However, the analysis of her tumor suggested she might benefit from immunotherapy. She took the opportunity to participate in a clinical trial combining chemotherapy with an immune checkpoint inhibitor against PD-L1.

She began her immunotherapy treatment in August of 2017. By December, things had improved dramatically.

“When they took the tumor out with my mastectomy, it was all dead cells. The tumor had all been killed,” says Lori.

She had a complete response from immunotherapy, thanks to the personalized care offered by the Breast Cancer Moon Shot.

“To know that MD Anderson was doing everything they could to find a cure, or a treatment that would be successful, really meant a lot to me,” Shults says. “It made me feel a lot better, it comforted me when I was pretty worried in the beginning.”

Today, Lori remains cancer free and is thankful for the hometown hero that made her treatment possible.