Kilmer, who works in marketing and public relations at Black Hills State University in Spearfish,
joined a clinical trial for liquid biopsies because
she wanted to contribute to research. Patients in
the study provide blood biopsy samples to help
scientists learn more about the molecular drivers
of cancer. Kilmer’s results, along with her symptoms,
influenced her treatment.
She was initially diagnosed with hormone-receptor positive, stage IIB breast cancer in
September 2011. She went into remission after treatment at the Regional Health-John T. Vucurevich
Cancer Care Institute in Rapid City, South Dakota,
that included a double mastectomy, chemotherapy
and radiation. She also took tamoxifen for three
years to try to keep the cancer from coming back.
In May of 2015, Kilmer noticed swelling in her neck.
After scans and a tissue biopsy revealed that her cancer
had metastasized, her oncologist prescribed Ibrance
(palbociclib), a targeted drug for metastatic hormone-receptor positive disease, and Femara (letrozole), an
aromatase inhibitor. Her doctor also sent her tumor
sample to Foundation Medicine. After the test revealed
a mutation in the m TOR pathway, Kilmer switched
to Avera Cancer Institute for treatment in September
2015. Her oncologist there added Afinitor (everolimus),
an m TOR inhibitor. The goal, Kilmer says, was to block
as many cancer pathways as possible. Her scans have
shown no evidence of disease since then.
Kilmer had her first liquid biopsy as part of
the clinical trial in January 2016. Four months
later, in May, her liquid biopsy showed a mutation
linked to resistance to Ibrance. Her biopsy that
August revealed increases in the same mutation. By
September, she began experiencing lymphedema,
or swelling, in one arm and an uncomfortable pressure in her chest.
At that point, Kilmer says, she and her
oncologist had to make a decision. “Do we
watch it longer, or do we try to get on top of it?”
Kilmer asked. Despite her clean scans, they decided
to act. Kilmer switched to Votrient (pazopanib), a
tyrosine kinase inhibitor. It was like flipping a switch,
she says. “Within just a few days, the swelling started
to go away.” So did the pressure in her chest.
Subsequent liquid biopsies have shown no signs of
that mutation. (Because of side effects from Votrient,