Living for Today, Metastatic Breast Cancer Patient Has ‘All I Need’

Krista Lawrence likes to joke with her two adult children that they don’t need to get married and have their own kids just because she has metastatic breast cancer. In fact, thanks to her excellent response to a clinical trial at the Susan F. Smith Center for Women’s Cancers at Dana-Farber, Lawrence is enjoying each day with her incurable disease—and not worrying about an unpredictable future.

“I’ve accepted the reality of my diagnosis, but that reality does not have to be negative,” says Lawrence, 56. “I would not say that cancer is a gift, but the byproduct or changes that came as a result of my diagnosis are a blessing. I am able to be more present, in my relationships and all the things that I do.”

Life before cancer was hectic, says Lawrence, who juggled being a single mother of a teenage son and daughter and a high-pressure job as a human resources professional. When she was diagnosed with breast cancer in 2009, she had surgery followed by months of chemotherapy and weeks of daily radiation at a hospital near her home outside Hartford, Connecticut.
In July 2014, Lawrence’s then-care team discovered that the cancer had advanced to both of her lungs. She had stage IV metastatic breast cancer.

“All I could think was ‘How did this happen?’” Lawrence recalls.

She sought a third opinion in the Susan F. Smith Center at Dana-Farber, where she met Erica L. Mayer, MD, MPH, a senior physician within the center’s Breast Oncology Program. The timing was perfect—a spot on a clinical trial, which was evaluating new therapies for hormone receptor positive breast cancer, had just opened up. Mayer thought Lawrence would be perfect for the trial.

“I didn’t have to think long,” Lawrence says.

The trial combines a classic hormone-blocking medication, tamoxifen, with a targeted medicine called abemaciclib. This drug inhibits cancer cell growth by shutting down a complex called CDK4/6, often found to be overactive in hormone receptor positive breast cancer.

When Krista started on the trial, abemaciclib was still in development. But with contributions from her as well as many other patients, the drug was approved by the U.S. Food and Drug Administration in 2017 as a standard therapy for metastatic hormone receptor positive HER2 negative breast cancer.

For Lawrence, the trial—which she started on in August 2014—has been a life-changer. She takes oral medication twice daily at home, and her disease has stabilized to the point where she is now on the lowest dose possible for trial participants. The medication was approved by the U.S. Food and Drug Administration in 2017 as standard care for metastatic breast cancer patients.

Patients, including Lawrence, have reported side effects from abemaciclib, including fatigue, aching joints, and gastrointestinal challenges, all of which can occur with no warning. But Lawrence plans to continue on the trial medications as long as they are effective for her. She comes to the Susan F. Smith Center in Boston for monthly check-ups with Mayer or her nurse practitioner, Elahe Salehi, DNP, ANP-BC. She is also involved with a metastatic breast cancer support group at Dana-Farber that she says has become like a second family.

“We are delighted with how well Krista has done on this important trial,” says Mayer, “and are proud of how her contributions have helped breast cancer patients around the world have access to better therapies for their disease.”

With Mayer’s support, as well as that of her children and friends, Lawrence took an early retirement from her job in 2016. She now takes trips to places like Montana, where her daughter lives, and Paris, where in 2016 she revisited sites first seen on a 1984 college backpacking trip—this time with her son. She also writes and does advocacy work in and outside Dana-Farber in an effort to spread the word to other cancer patients that one can live a full life with metastatic disease.

“I have everything I need, because what I think I need has changed,” she says. “My life now gives me the freedom to be with the people I most care about, and to be there for the people who most need me. And while I know my disease may get worse at any time, I’m not letting that fact define me.”

A third trip to Paris, this time with girlfriends, is tentatively planned for March. That’s as far into the future as Lawrence cares to plan, and that’s the way she likes it.