A conversation how to beat cancer
Recommended Book:
Living Proof by Harry Connick Jr.
Mentioned Link:
Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes, and business success, with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.
Saul Marquez: And welcome back to the podcast. Today I have a different angle on things. I wanted to give an opportunity for a patient’s story and a little expert angle on patient’s story that we’re gonna be sharing today. I’ve got Elizabeth Bynes and Dr. Denise Yardley. So Elizabeth was just 35 years old and caring for her six-year old son when she felt the small lump in her breast. Initially misdiagnosed, she got a second opinion at Mayo Clinic Hospital Phoenix where she learned she had Stage 3 B breast cancer HER2+. It’s a Human Epidermal Growth Factor Receptor 2. We’ve got Dr. Yardley who’s going to dive in a little bit deeper to tell us and educate us a little bit more on what that is. But Elizabeth basically had an aggressive form of the disease that required treatment A.S.A.P.. She was overwhelmed until she chose to participate in Genentech Access Solution program which helped her fund her her two targeted treatment regimen. Thanks to this decision Elizabeth credits, Genentech for giving her her life back, her and her care team. And it’s a pleasure to have her on the podcast. A little bit on Dr. Denise Yardley. She joined Sarah Cannon in 2000. She’s a Senior Investigator Breast Cancer Research Program at Sarah Cannon Research Institute. She’s a Senior Investigator in the Breast Cancer Research Program in this role, she serves as Principal Investigator on numerous Breast Cancer Clinical Trials. So she’s very knowledgeable on this. She’s also a recipient of the American Cancer Society Oncology Career Development Award and many more so it’s a big pleasure to have you both on the podcast today. Thanks for joining me.
Dr. Denise Yardley: Thank you.
Elizabeth Bynes: Thanks for having me.
Saul Marquez: So I want to get the podcast started by number one just saying welcome and asking both of you to sort of give an intro on how you got here through your experience with cancer. So let’s start there. So why don’t we kick it off with you Elizabeth and then Denice you can follow.
Elizabeth Bynes: Okay. So do you want to know how I came to have HER2+Cancer so back when I was thirty five years old,I felt a small love in about February of 2014 and I was kind of shy to show my family doctor about it. And I finally did about a few weeks later I made the appointment and then he kind of told me there’s really nothing to worry about. So you know I just sort of took that at face value and kind of went about my life. And several months later in about September all of a sudden I noticed it started to really sort of rapidly grow and it grew to the size of half a lemon within I’d say about six weeks. So immediately I went back to his office and showed him and he was completely I thought it was a 100% and told me I really shouldn’t be concerned. But at this point I said well what’s the next step. And you said well you can have an ultrasound. You know I really don’t need it. So I went for an ultrasound and I have there also report even now to this day and it says it was all just component but I kind of really pushed for an appointment with a surgeon because I wanted this monstrosity off of me. So I ended up waiting another month and having an appointment at my local hospital breast clinic and the doctor there seemed very concerned when she first saw me was the State recruit good bye. And she sat me for a mammogram right there and within 20 30 minutes they’re telling me that I have cancer and advanced cancer which was a huge huge shock. And it turns out that her 2 positive cancer does grow like that that you know. But everything I’d read online had said that cancer is very slow growing. And so everything my doctor saying really kind of made sense at the time. So it was a big shock. Definitely definitely.
Saul Marquez: And when you get into this type of situation I mean it’s it’s definitely tough. So Dr. Yardley maybe you could fill us in a little bit about your experience with this, how it grows so fast, why? we’d love to hear your angle on it.
Dr. Denise Yardley: Sure. I think oncology and specifically this subtype of breast cancer just now having the knowledge and the ability to classify breast cancers into separate subtypes that we can really make appropriate treatment decisions has been something that’s happened during my career. The whole story about her too has evolved to now really understanding what that means and so I think Elizabeth’s story is exactly what we knew about HER2+Breast Cancers once we were able to identify that and to step back what that means or the picture, I kind of discuss with my patients is if you think of a cancer cell. And I always try to give a picture of what this thing or entity of her to is. It’s sort of like a a flag pole or an antenna on the surface of the tumor cells to normal cells have this but in a much reduced quantity maybe two or three in comparison to a HER2 supercharged tumor cell which may have thousands to a million of these antennas or flagpole sitting on the surface of their cells and what the purpose of this HER2 flag pole is is it’s supercharged to capture any growth signal or stimulus in the patient’s body so different factors that can stimulate tumor growth or as I talk to patients. It’s like a flag it just floating around in the body. It finds the cell that has a thousand or a million of these flagpoles and these flags bind to it and stimulate growth. And so just as Elizabeth story, this type of breast cancer is just sitting there waiting for these growth signals with all the ability to capture every little one that goes by and results in a very rapid cell grow. I think the exciting part for myself as a medical oncologist and clinical is the fact that during my course of oncology I have been able to see the ability to describe that type of cancer. But that wasn’t very helpful other than letting patients know yes this isn’t an aggressive cancer but patients often we’re very aware because they were experiencing this but we were able to really see a partnering now of the science of understanding what this is in a HER2+Cancer in seeing how our pharmaceutical partners were able to take that science and developed a very specific drug so that drug the initial and first drug for the HER2+Beast Cancers was a drug called Herceptin and developed by Genentech. And you can kind of think of her steps in as a flag. So these tumor cells that have a thousand flagpoles waiting for a growth signal. Herceptin was like a flag that attached to these flagpoles and blocked the ability of the growth signal to sit on that flag and signal tumor growth. And so in 1998, the first HER2 specific drug was approved. And since then we’ve had many more as a welcome addition to be able to treat patients with HER2+Breast Cancer. But that particular science coupled with the ability to develop a drug has now changed that whole prognosis of patients coming in with a HER2+ super charge rapidly growing aggressive breast cancer into being so unique to have a specific medicine that really turns all of that off. And that’s been the most exciting part of my careers to be able to see that medicine see it in action and a patient participate in some of the trials and now see us. Welcome three and four and five new drugs that are only specific for those HER2+Breast Cancers.
Saul Marquez: Now that’s super fascinating. Yeah I never understood the way this works, the flagpole analogy was a brilliant way of explaining that. Elizabeth you’re about to say something?
Elizabeth Bynes: Yes exactly. What Denise just said is when I first found out that I had cancer I didn’t initially know that it was HER2+ for the first three weeks. So when I had my biopsy done they told me I had cancer and my biopsy came back as estrogen receptor positive and progesterone receptor positive. But HER2 test was still out. So I wasn’t sure when I actually went to Mayo Clinic for a second opinion because my local hospital couldn’t see me until after Christmas and it was only the end of November. Apparently getting cancer around the holidays here is very inconvenient. We went to Mayo Clinic and they had that was the first thing they said was that one of my tests was out but it had been rapidly spreading. It was now if I left those that had an enlarged lymph node in my armpit and so they wanted to start me at a base chemotherapy. So I did two one round of chemotherapy and then when the HER2 test came back it actually came back the morning of my second round of chemo and so they talked about adding these drugs which is sort of a lot to take in at the time. But my oncologist said that this is actually a good thing. He said other than costs of drugs these drugs will save your life and that we’ve had excellent responses with these types of drugs and they wanted to add in Herceptin and Perjeta and that I would have six rounds of those drugs and then I would have would wait a month and have surgery and then continue on Herceptin for the rest of the year every three weeks. But it was really amazing to see you know as by the time I had my third round of chemo, my tumor was virtually gone. I went from having this huge growth on the side of me to it wasn’t even you couldn’t even feel it anymore. So I really knew that these drugs and my treatment was working which is exactly what you want to see when you’re a cancer patient.
Saul Marquez: Yeah beautiful now. Thanks for sharing that Elizabeth and yeah I mean when you’re in that situation and you know you call it out Elizabeth you know you’re in the holidays, things get hectic. If you have HER2 Cancer that’s growing so fast, I mean you need to get in there get treated A.S.A.P. so definitely nerve wracking experience but thankfully as Dr. Yardley mentioned the science has has advanced to the point where we’re now being able to understand and categorize the different types of cancers out there and respond to them in such a way that will help us knock them out effectively. So thinking about the solutions I know there was an element here Elizabeth where you at the time maybe didn’t have insurance?
Elizabeth Bynes: Yes. I didn’t have insurance which was a huge huge factor for me. You know when we first went to Mayo Clinic you know to even start to get an opinion to sort of get the ball rolling. I had every intention of coming back to my hometown and doing my treatment here once they could see me. But the big thing here were where I live was they couldn’t offer me they wouldn’t offer me Perjeta and I was told by my oncologist that this was extremely important for somebody my age, my tumor size that you know fight it with all that we could. So we literally packed up, moved to Arizona, bounced around between how relatives houses and hotels until we could find somewhere to rent and live and my son at the time was four years old and we took him out of school and it was hard to move there and then not only to have you know a life threatening illness all of a sudden without insurance. And you know we’re thinking that the things are pretty grim financially that we’re probably going to have may have to sell our house. Who knows what’s going to happen and you know the drugs are new and they’re quite expensive and the beginning of my diagnosis I really didn’t know too much about my diagnosis. My husband was like a total champ and he read everything about it and knew everything and about six weeks into my treatment I really started to kind of want to know. And I felt like the shock was over. And so I actually googled the drugs I was taking Herceptin and Perjeta and I saw a link on their website that said about their access to Care Foundation Access Solutions. And at first I thought well that can’t be right. You know it sounds too good to be true kind of thing. And I waited a couple days and I filled everything out online and I printed it out. And so it’s as mine was about four years ago now. Things are I think now you can do everything online but back then I printed the fax and got my doctor’s office to fill out their portion of medical necessity and all of a sudden all my last day of treatment they called me and said that I was approved and I just couldn’t believe it that I was you know that they were going to pay for my drugs from now on. And I told them that we had actually already paid for the first six treatments and they ended up backdating it to the beginning of my treatment which was…
Saul Marquez: It’s amazing.
Elizabeth Bynes: Amazing. And even the people at Mayo Clinic had never heard of the foundation like and they were just blown away. And like I wish I had googled it sooner. It was definitely you know I felt like I was too hard hit to do so much research initially but I just so like it was just such an amazing gift I just started sorry i got teary on the phone with the gentleman that called me from Symantec to tell me that. And you know it’s sort of just took the huge burden off but you know now I wasn’t worried about what was going to happen financially as much you know other parts of treatment are still expensive but the chemo drugs were you know what I really needed and it was just it was amazing to know that when I go to the hospital that all I had to do is pay for my infusion fee and that was it.
Saul Marquez: Yeah. That’s amazing. It’s a hand came out of the sky and sort of gave you that assistance, it’s Genentech’s Access Solutions program we’ll put a link on the show notes for that for those listening that are intrigued or interested in learning more, thanks for sharing that Elizabeth.
Elizabeth Bynes: Yeah.
Saul Marquez: So Dr. Yardley you’re a frontline practitioner and also a researcher. What do you want to share with the listeners as as sort of things to keep in mind as they take care of themselves. And also if they’ve found something that they need to address.
Dr. Denise Yardley: So I you know I think there’s lots of things to kind of keep in mind. I think Herceptin and the understanding of the HER2 biology of a cancer cell and the ability to link that with a medicine was just really pivotal in breast cancer. You know the only real targeted therapy we’d had prior to that was the endocrine or the hormone blocking medications. And so now we’ve just seen that door really open to continue to welcoming and what I get to see as a investigator is taking the power of that HER2 targeted therapy or therapy from Genentech and now seeing how we can improve upon that. And you know one of the important things is these two drugs Herceptin and Perjeta are not chemo drugs. They’re biologic targeted agents with a very favorable profile and that’s led now to the development of a drug that is sort of a compound of those with chemo and the HER2 targeted therapy all together. But what’s unique is it very much like Herceptin. It’s a flag that binds to the flagpole and gets taken down like a flag would and released inside of the cell so we’re able to spare patients the side effects of chemotherapy because it’s released actually inside of the cells. So there’s one drug that just got approved in the advanced HER2 patients that are in clinical trials for early stages like Elizabeth. So you know I think what we’re learning is now trying to de-escalate therapy and just provide the amount that a patient needs in trying to improve upon the side effects trying to you know now that we have these two non chemo drugs and we understand the biology, we’re really exploring trying to move away from chemotherapy. It’s very active but it does have some inherent side effects. So I think we’re really excited about that and I would say also for those that are interested in the HER2 story, Harry Connick, Jr. was in a movie a Lifetime movie. I mean I think that’s just the fascination with this whole science and industry link and improved patient outcomes called living proof. And it was Dr. Lehmann who I know and we’ve all worked in the breast cancer community who provided the story in a lifetime movie format of how that science came to being to a drug it’s a great movie and I share that with my HER2 patients just really in our lifetime. This has happened so dramatically changed the patient’s outcomes and decrease the poor outcomes by 50% just dramatic with a non chemo drug. And so I think there’s every bit of hope for patients because the science is so well understood and our industry is really helping us develop very smart targeted therapies that continue to improve the outcomes of patients facing a diagnosis of breast cancer.
Saul Marquez: Super exciting for sure. Dr. Yardley and yeah I mean just knowing the advancements that are being made potentially you may not even have to have chemo. I mean there’s some great stuff happening here. I definitely am excited to hear the developments and even the you know think about the future you know where there will be. Just like something that’s routinely removed. It’s just exciting. I’ve really enjoyed this conversation a lot. We’re here at the end of the podcast. So what I’d love to do is ask you both for your closing thoughts you know so please Elizabeth let us know what do you want to leave the listeners with and then Denise Yardley will end that with you.
Elizabeth Bynes: Well my biggest call to action would be to be an advocate for your own health. If something doesn’t feel right to say something and push further opinion. And if you are diagnosed with cancer look in to all of your options available and there’s life saving drugs out there like Genentech makes for my type of cancer that has totally saved my life. And I wouldn’t have had them otherwise if I hadn’t gone the extra mile, got a second opinion and had such a fabulous outcome from the drugs that I received.
Saul Marquez: Right. That’s clear.
Elizabeth Bynes: So that would be my advice.
Saul Marquez: Great message there. And you said the extra mile and one of my favorite things you folks now that I always say there’s no traffic in the extra mile. So when you feel like you’re getting to the end there go that extra mile there’s absolutely no traffic. Dr. Yardley?
Dr. Denise Yardley: Sure. I would just really go and put a plug in for you know really as Elizabeth did sought out additional opinions, I think that’s of paramount importance to a patient. And I would underscore that with asking physicians about clinical trials. The clinical trials that are available these days are so different from I think some of the historical mindsets where you really get the opportunity of either standard of care or standard of care plus a potential bonus card that can continue to improve the outcomes and so I think the design of the trials now are just fantastic where you either get what you would get ordinarily or the potential of an additional drug. So having participated in the chemo versus chemo plus Herceptin and seeing Herceptin and approved in early stage patients in 2005 having participated in those Perjeta trials and seeing them come to FDA approval initially 2012 for advanced patients and then in Elizabeth setting that just happened in 2015 based on patients who were willing to participate in these trials and in help really move the progress in treating HER2+ patients and improving the outcomes for all patients now and so I’d always say ask if there’s a clinical trial that you might be eligible for or get the information to see if that’s something that would potentially be a benefit to you.
Saul Marquez: Well great piece of information there, Dr. Yardley. Thanks for your expertise. Elizabeth thanks for sharing your experience. And thank you both for taking your time to be with us today. We will definitely be looking to stay in touch. And again a big thanks for joining us.
Elizabeth Bynes: Great
Dr. Denise Yardley: Thank you.
Elizabeth Bynes: Thanks again.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.
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