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“You’re replaceable at work,” the patient said, reflecting on her experience. “You’re not replaceable with family.”
A recent circulating tumor DNA blood test for a Geisinger Hazleton patient has yielded a negative result, showing no detectable cancer DNA in her bloodstream. This milestone comes more than a year into an aggressive battle against triple-negative breast cancer (TNBC), a malignancy known for rapid growth and spread that demands swift, multi-modal intervention.
A Grueling Regimen of Chemotherapy and Surgery
Under the guidance of medical oncologist Jose Castillo, MD, the patient began an intensive treatment plan immediately following her diagnosis. The protocol required 20 rounds of chemotherapy, beginning with weekly infusions for 12 weeks. This was followed by a combination of doxorubicin and cyclophosphamide, a regimen frequently referred to by patients as the “Red Devil.”
In August, the surgical phase commenced. Breast surgeon Rosemary Leeming, MD, and plastic surgeon Sean Devitt, MD, performed a double mastectomy and lymph node surgery. The recovery was fraught with complications, including a readmission for high-dose intravenous antibiotics after an allergic reaction. The patient managed surgical drains through Labor Day, and subsequent pathology reports confirmed cancer in a lymph node, requiring further therapeutic measures.
Precision Radiation via Breath Hold Technique
Following surgery, the patient moved to Pottsville for five weeks of weekday radiation therapy directed by radiation oncologist Gregory Treharne, MD. Because the tumor was located on the left side of the chest, the clinical team employed the deep inspiration breath hold (DIBH) technique to protect the patient’s cardiac health.
“The DIBH separates the heart from the targeted structures receiving radiation, which means the heart receives less incidental radiation exposure,” Dr. Treharne explained. During each session, the patient held her breath to expand her lungs, physically shifting the heart away from the chest wall targeted by the radiation beams.
Ongoing Therapy and Clinical Outlook
The patient is currently receiving immunotherapy and has initiated a regimen of oral chemotherapy. While Dr. Treharne noted that she has tolerated the treatment well, both the physician and the patient remain guarded. The treatment plan extends for at least one additional year.
Chemotherapy and ctDNA Testing Treat Triple-Negative Breast Cancer
Triple-negative breast cancer is defined by its lack of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2). Because these tumors do not respond to common hormone therapies, chemotherapy remains the primary clinical approach.
In cases involving left-sided tumors, the DIBH method is used to minimize radiation dose to the heart. Meanwhile, circulating tumor DNA (ctDNA) testing serves as a blood-based diagnostic tool to monitor for genetic evidence of cancer in the bloodstream. While a negative ctDNA result is a positive indicator of response, it does not replace standard clinical surveillance.
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