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When Amy Charney was diagnosed with HER-2 positive breast cancer in November 2014, she told Lisa Carey, MD, she preferred a therapy that would allow her to continue her active life as a mom, wife and avid runner. Dr. Carey identified a clinical trial for Amy was eligible, and is happy to report the novel treatment proved to be effective and have fewer side-effects.

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Amy Charney
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Lisa Carey, MD

Clinical trials are an important step in discovering new treatments for breast cancer and other diseases, as well as new ways to detect, diagnose, and reduce the risk of disease. While clinical trials provide evidence of what does and doesn’t work for patients, trials also help researchers and doctors decide if the side effects of a new treatment are acceptable when weighed against the benefits. On average, a new medicine to treat breast cancer has been studied for at least six years – and sometimes, many more – before a clinical trial testing the efficacy of the medicine begins.

The following patient profile features Amy Charney, a wife, mom and avid runner. Amy had already registered to run the 2015 Boston Marathon when she was told she had breast cancer. But her diagnosis didn’t stop her from reaching the finish line.

Who says you can’t go home?

Amy’s diagnosis came as a complete surprise back in November 2014, when her family was getting ready to celebrate her daughter’s Bat Mitzvah.

“We’d gone shopping for party dresses, and I was trying on some things in the fitting room,” says Amy. “And that’s when I saw it: a small, pea-sized lump on my breast. I made an appointment with my doctor, and since it was almost time for my annual visit, she suggested I have a diagnostic mammogram. That’s when I came to the N.C. Cancer Hospital.”

Amy’s mammogram results were negative, but because she has dense breasts, her breast radiologist recommended an ultrasound, which led to a biopsy. Amy was diagnosed with ductal carcinoma in situ, or DCIS, the most common type of non-invasive breast cancer. After evaluating her options, Amy chose to have a lumpectomy and radiation. However, her case was sent to the radiology review board. Due to the density of her breasts, they wanted more information and asked Amy to have an MRI.

Those results showed even more DCIS in the tissue, and after another biopsy, the board strongly suggested that Amy have a mastectomy. On January 13, 2015, David Ollila, MD, surgical director of the UNC Breast Center, performed a partial mastectomy and sentinel node biopsy. Fortunately, Amy’s lymph nodes were clear, but she did have a six millimeter stage 1 invasive breast cancer called ‘HER2-positive’. Her oncologist, Lisa Carey, MD, medical director of the UNC Breast Center, recommended chemotherapy for Amy.

“Years ago, this was worst, most aggressive type of cancer,” explains Dr. Carey. “But then studies began to show that the anti-HER2 drug Herceptin, combined with chemotherapy, really changed the game and made it a much more treatable cancer. But questions remain about the best way to administer these treatments.”

Dr. Carey explains that normally, patients are given high doses of several chemotherapy drugs with Herceptin added, followed by completion of a year of Herceptin. However, while this treatment protocol is very effective, the side effects can be tough on the patient. “So when Amy and I talked about her treatment options, I told her about a clinical trial initiated by colleagues at Dana-Farber Cancer Institute. UNC is part of a group of academic institutions that work together on trials like this one,” says Dr. Carey. “In this study, we’re using a new drug called trastuzumab emtansine, known commercially as Kadcyla, which is a chemotherapy drug attached to Herceptin, so the chemotherapy only goes into the cancer instead of all over the body. The combination is called TDM1, but its nickname is the ‘Trojan Horse’ because it’s such a targeted form of treatment. I was pleased that Amy agreed to be a clinical trial participant.”

Running the 2015 Boston Marathon

Off and Running

Amy began taking TDM1, but still, she kept on running with her doctor’s permission. Then on April 20, 2015, just six days after a chemotherapy treatment, Amy stood at the starting line of her seventh Boston Marathon while her husband Jonathan and daughters Julia, Elisabeth and Ava cheered her on. “I kept thinking, ‘You can’t finish if you don’t start.’ I just wanted to cross the finish line, not necessarily beat my own time. And before I knew it, we were off and running.”

The Boston Marathon is a grueling race with a course that winds through eight Massachusetts cities and towns. One of those is Brookline, the place where Amy grew up and where her mother, who died of lung cancer, was laid to rest. “Miles 22 through 24 of the Marathon run through my hometown,” explains Amy. “It was a pretty emotional moment for a number of reasons.”

Amy crossed the finish line feeling exhausted, relieved, and most importantly, like a champion. “By running the Boston Marathon, I learned that, in spite of breast cancer, I am still me,” she says. Meanwhile, Dr. Carey says she’s happy with Amy’s response to the clinical trial drug and looks forward to seeing the final results of the study. “We’re finding that it’s as important to tailor a patient’s course of care to less treatment if possible, as it is to tailor care to more treatment if necessary,” says Dr. Carey. “It’s good to have options.”