It began with a self-exam. Caitlan Reese, then 29, discovered a lump in her breast in October 2019. For this fourth-grade teacher, the discovery kicked off a month of appointments, including a mammogram, ultrasound and biopsy. Then, during the week of Thanksgiving, Caitlan received her diagnosis: triple-negative breast cancer.
Triple-negative breast cancer is rare, accounting for about 10 percent of all breast cancer diagnoses – but it’s most frequently diagnosed in people who are young and African American. Triple-negative breast cancer, which is more aggressive and likely to spread than other forms of breast cancer, is defined by what it lacks. It doesn’t have the three receptors that breast cancer usually has: estrogen, progesterone or a protein called HER2. That means that in addition to being more aggressive, it can be more complicated to treat.
Caitlan lives in Hickory, but her doctor referred her to breast cancer care at Atrium Health Levine Cancer Institute. She’s not alone in travelling for treatment here; due to the expertise of its team, Levine Cancer Institute has become a destination site for triple-negative breast cancer patients. Women from across the region come here for multidisciplinary treatment of this rare, aggressive form of breast cancer, as well as supportive oncology services.
“I’m so thankful to have the wonderful team at Levine Cancer Institute,” Caitlan says. “There is a department for everything here. Every random side effect, every long-term complication, they are so committed to my quality of life.”
A Team Approach for an Aggressive Cancer
Although triple-negative breast cancer has had fewer treatment options compared to other forms of breast cancer, it’s been the subject of recent innovations that are changing that.
“There have been a lot of advancements to the treatment of triple-negative breast cancer that are really exciting,” says Antoinette Tan, MD, the chief of breast medical oncology at Levine Cancer Institute and Caitlan’s oncologist. “There have been three major drugs approved to treat triple-negative breast cancer, and now we have novel targeted agents that have really made an impact in keeping patients free of disease longer or keeping their disease stable over time.”
Caitlan had tremendous success with chemotherapy, surgery and radiation for her breast cancer, with no signs of cancer remaining. About six months after her treatment ended, however, she had a seizure at work that led to another diagnosis: her breast cancer had developed into a brain tumor.
“Sometimes, there may be a rogue cell that may be resistant to chemotherapy that may harbor somewhere in the body. For Caitlan, it was her brain,” Dr. Tan says.
For her brain metastases, Caitlan was one of the first patients at Levine Cancer Institute to undergo a new treatment method. Before surgical removal of her brain tumor, she had three targeted radiation treatments. This approach incorporated two advancements based on groundbreaking research done at Levine Cancer Institute.
“The practice has been to do surgery first, then radiation after. That’s how it’s always been done. We thought outside the box and saw that doing radiation before surgery can have definite potential advantages, with less inflammation and less chance of recurrence,” says Roshan Prabhu, MD, Caitlan’s radiation oncologist. “In addition, Atrium Health was one of the first health care institutions to show that doing focused radiation treatments can lead to outcomes just as good as whole-brain radiation, but without the detriments to cognition, memory and quality of life.”
This method has since been adopted by cancer hospitals around the country, giving more brain tumor patients better outcomes and fewer complications. “People have gotten so enthusiastic about this method that it’s being used at other premier cancer institutions now, too,” says Dr. Prabhu. “We're using this data cohesively to drive the field forward.”
After her targeted radiation and surgery, Caitlan had no evidence of disease remaining in her brain. Even so, this aggressive form of cancer spread to her liver. She briefly joined a phase 1 clinical trial for her liver tumor, and then continued with chemotherapy and immunotherapy for her treatment.
“Caitlan is a very positive and kind-hearted person,” Dr. Tan says. “That’s displayed in her willingness to participate in a clinical trial so she could contribute to our understanding of triple-negative breast cancer and to develop more innovative and novel approaches to it.”
As Caitlan’s treatments progressed, her care team grew. All of the departments who treated her – including medical oncology, radiation oncology, surgical oncology, neurology and neuropsychology – coordinated their care and shared information regularly.
“Our teams talk to each other a lot, which is great because this coordination of care for patients means we’re able to treat patients holistically, instead of each team being in its own silo,” Dr. Prabhu says.
Not Just Treating Cancer, But Caring for Caitlan
As these teams collaborated in Caitlan’s cancer treatments, even more teams supported her personally. One way they supported her was to help her through the side effects of chemotherapy. Caitlan’s always been healthy – she’s never broken a bone or even been stung by a bee – and she was concerned, understandably, about side effects.
“We have good supportive care specialists who can help patients through chemotherapy by lessening side effects like nausea,” Dr. Tan says.
In addition, the Levine Cancer Institute team introduced Caitlan to the fertility department for fertility preservation treatments. This maximizes her chances of having a family after undergoing chemotherapy. They also introduced Caitlan to the Young Women’s Breast Cancer Program, which is co-directed by her surgeon, Lejla Hadzikadic-Gusic, MD.
“I’m loving all the virtual options!” Caitlan says. “I have been to the virtual support group meetings, the cooking classes and virtual yoga.”
Her care team also incorporated virtual appointments when necessary to minimize the disruption to Caitlan’s life and work.
“A lot of patients find that a cancer diagnosis becomes their full-time job,” says Dr. Prabhu. “When we could, we’d schedule virtual appointments with Caitlan that she could have during 15-minute breaks between teaching classes, as opposed to her taking a whole day off from work. She still had all the best care without it being as disruptive to her daily life.”
Caitlan’s Next Chapter Starts with a Big Day
“Metastatic triple-negative breast cancer is not a curative condition, but it is absolutely very treatable,” Dr. Tan says. “Caitlan’s treatment will continue, but with the advancements that we’ve had, she certainly can have a good quality of life and live her life fully, and she’s showing us that.”
Caitlan spends much of her time now looking ahead – to one day in particular. She and her fiancé Andrew Killian will marry in February. She’s gotten the gown, she’s hired a planner, and she’s just a few months from their “I do’s.” She says that while she never expected to shop for a wedding gown while she didn’t have any hair, she’s keeping her planned wedding date even as she continues treatments. She’s ready to move forward with the confidence, love and gratitude the past few years have given her.
“When people are diagnosed with cancer, they have no idea the love they will be showered with through this whole thing. There have been so many sweet moments and memories,” Caitlan says. “That is my prayer for others with cancer: Even when you may feel isolated and alone, remember there are so many people who will walk alongside you and give you so much love and support. “
Learn more about breast cancer care at Levine Cancer Institute or call 704-302-9270 to make an appointment.
