Most metastatic breast cancers arise months or years after the initial diagnosis and treatment. I’Quasia Russell, however, was among the 6 to 10 percent of people for whom metastatic disease was their first cancer diagnosis. Russell has been treated by Sylvia Adams, MD, director of the Breast Cancer Center at NYU Langone Health’s Perlmutter Cancer Center, since her diagnosis in March 2016.

“I’Quasia has done extremely well over the last several years,” said Dr. Adams, who also is a professor in the Department of Medicine at NYU Grossman School of Medicine. “Importantly, she has been able to fulfill her dream and go back to school for her nursing degree, while working full-time and being a mother of two. It takes an amazing amount of strength for a person to go through this, and I’Quasia has shown that strength. She’s a fierce fighter.”

“Working in the medical field and knowing the different problems that arise with metastatic breast cancer, you know what you’re going to have to deal with if you try a treatment and then it doesn’t take as well as you expected it to take,” Russell said. “So now you’re trying another treatment and now you’re like, what if this doesn’t work? Am I going to run out of treatment options to where it’s just I have to deal with what’s next?”

During the course of her treatment, Russell benefited from several new drug approvals that serendipitously occurred just as she needed something new to treat the cancer.

Russell was initially treated with chemotherapy and the HER2 inhibitor trastuzumab (Herceptin). As the cancer progressed in her liver, she started a newly approved antibody–drug conjugate called trastuzumab emtansine (Kadcyla). After Kadcyla stopped working, she received a PARP inhibitor, a newly approved drug for certain breast cancers with a deficiency in DNA repair. Months later, after the cancer progressed, Dr. Adams said that Russell was in a great deal of pain from the metastatic disease in her liver. Around that time, another antibody–drug conjugate, fam-trastuzumab-deruxtecan-nxki (Enhertu), was approved for HER2-positive breast cancer.

“Enhertu is a very powerful drug,” Dr. Adams said. “I’Quasia had a very rapid improvement in her symptoms and her pain subsided within a week. The benefit of that drug lasted for two years, which is incredible with prior pretreated breast cancer.”

When the cancer metastasized to Russell’s brain, she had stereotactic radiosurgery with Douglas Kondziolka, MD, the Gray Family Professor of Neurosurgery in the Department of Neurosurgery and a professor in the Department of Radiation Oncology at NYU Grossman School of Medicine and director of the Gamma Knife Program at Perlmutter Cancer Center. Russell’s brain scans have been clear since. When the cancer in the liver began to grow again, she benefited from the approval of ribociclib (Kisqali) and palbociclib (Ibrance), members of a new class of cancer drugs for metastatic breast cancer called CDK4/6 inhibitors. She is monitored every three months with brain MRIs and visits with her treatment team monthly.

“I’Quasia is doing very well and she looks great,” Dr. Adams said. “Our goal when we meet with women who have metastatic disease is to provide hope. We encourage them to think about metastatic breast cancer as a chronic illness where they receive treatment like they would for blood pressure or diabetes. The treatment goals for metastatic breast cancer are designed to maintain a good quality of life and extend survival. I’Quasia has definitely had extended survival from the treatments.”