Lucia’s Story: A Complete Response After Triple-Negative Breast Cancer

Lucia Ewing tried her best to enjoy the holidays with her family, but she couldn’t stop thinking about the lump in her breast. She had discovered it while taking a shower and immediately felt fearful.  
 
“We were traveling with our kids, and that lump was always in the back of my mind,” said Lucia, 61, a resident of Rye, NY. “Then, when I finally had an MRI, I felt like it was a ticking time bomb, and I couldn’t get started with treatment fast enough.” 
 
In January 2022, Lucia was diagnosed with stage 2 triple-negative breast cancer. “Triple-negative” refers to when cancer cells test negative for both kinds of hormone receptors (estrogen and progesterone), as well as the HER2 receptor. Triple-negative breast cancer doesn’t have as many treatment options available, tends to grow quickly, and has lower survival rates than other types of breast cancer.  
 

With the help of her oncologist, Meghna S. Trivedi, MD, who co-leads the Hereditary Breast and Ovarian Cancer Program at the Herbert Irving Comprehensive Cancer Center (HICCC), Lucia enrolled in the I-SPY 2 clinical trial. I-SPY2 is a “platform” trial — the longest-running one of its kind — meaning that researchers study multiple treatments within the same trial.  
 
“Through the design of this trial, it allows us to closely monitor patients who are receiving novel therapies prior to going to surgery for breast cancer,” says Dr. Trivedi. “It also provides a secondary aim of trying to identify which patients may be able to de-escalate their treatment.” 
 
Traditionally, patients like Lucia would receive a standard regimen of chemotherapy involving, 12 weeks of paclitaxel, plus 8 weeks of doxorubicin and cyclophosphamide. However, the second part of the regimen — in particular, doxorubicin — is particularly harsh in terms of side effects, causing heart toxicity, severe nausea, and total hair loss. Part of I-SPY 2 is investigating whether some patients can avoid doxorubicin and still maintain a good outcome.  
 
As part of the clinical trial, Lucia received a combination of three drugs: dostarlimab, an immunotherapy drug approved for other types of cancer but not breast cancer; carboplatin, an intravenous chemotherapy drug traditionally used to treat breast cancer; and paclitaxel, taken orally instead of the standard method intravenously. Lucia had a complete response after 12 weeks — and was therefore able to avoid the doxorubicin and cyclophosphamide.  
 
“I shaved my head preemptively, and then my hair didn’t fall out,” says Lucia, who had surgery and radiation therapy following the drug combination. “So that was kind of a surprise, but in a good way.”  
 
In June, Dr. Trivedi and her colleagues presented preliminary results of the I-SPY 2 trial arm that had Lucia as a participant at the American Society of Clinical Oncology (ASCO) Annual Meeting. Among 56 patients with triple-negative breast cancer, this combination therapy was found to be safe and moderately effective with an estimated pathologic complete response rate of 48%.  
 
Today, Lucia feels great, aside from some mild hearing loss and tinnitus in one ear. She spends time with her family and stays active by playing golf, cycling, and walking.  
 
“I don’t want to jinx it —recurrence fear being what it is— but I feel like I totally won the lottery,” says Lucia . “I got to participate in I-SPY and I could not have hoped for a better team of physicians and nurses at CUIMC. Dr. Trivedi is the best.”