When Kirsten Erlandsen was diagnosed with triple negative breast cancer in 2008, she approached her treatment like it was one of her road races. The mother of two knew that completing each treatment session brought her one stop closer to the “finish line” and her goal of becoming cancer-free.
However, after a year of running what she thought was a sprint, Erlandsen learned that her journey had morphed into a marathon.
A breast lump
Erlandsen first noticed a lump in her right breast early in 2008. Pregnant with her second child at the time, Erlandsen initially thought the lump might be a complication from her pregnancy. She knew something wasn’t right when it didn’t go away and it became extremely painful to breastfeed her newborn daughter.
It would take multiple visits to different doctors, but in August of that year, Erlandsen was diagnosed with breast cancer.
“I remember thinking, ‘I’m not sick, I don’t belong here,’” Erlandsen recalls.
Moving the finish line
After her diagnosis, Erlandsen, now 54, began treatment at a cancer center near her home in Connecticut. She received chemotherapy before undergoing a mastectomy and finished with radiation. It was during this final step that her team discovered a spot on her lung during a routine scan: Erlandsen’s breast cancer had spread.
“It took me a long time to work through the frustration, bitterness, and rage,” explains Erlandsen. “I felt I had done my time and finished my race; this wasn’t supposed to happen.”
Following this discovery in 2009, Erlandsen sought a second opinion. On the advice of a friend, she came to Dana-Farber/Brigham and Women’s Cancer Center, where she was introduced to Sara Tolaney, MD, MPH, associate director of the Susan F. Smith Center for Women’s Cancers.
Erlandsen was initially placed on a second chemotherapy regimen, but was later taken off less than two years later due to the drug’s toxicity. After this development, Tolaney approached her patient with the idea of partaking in a phase I clinical trial.
A life-changing therapy
At the time, researchers were experimenting with the drug sapacitabine, a chemotherapy medication that causes eventual double-stranded breaks in a cell’s DNA, making it difficult for cancer cells to repair themselves and resulting in cell death. In clinical trials, patients were taking sapacitabine in combination with a CDK (cyclin-dependent kinase) 2 and 9 inhibitor, seliciclib, which prevents DNA repair and enhances sapacitabine-induced cell death.
The research showed this combination to be effective in some patients with a BRCA mutation. BRCA1 and BRCA2 are genes that suppress tumors by producing proteins that repair DNA damage and keep cell growth stable. While Erlandsen did not have a true BRCA mutation, she was enrolled in the study due to having a “variant of unknown significance” (VUS). This meant that while she appeared to have a genetic mutation, it was unclear if it was harmless or whether it factored into the development of her breast cancer.
Erlandsen started the combination treatment in 2011 and her cancer had a complete response to therapy; she currently has no detectable disease. In July 2019, more than seven years after enrolling in the trial, Erlandsen began experiencing some side effects and it was decided to stop therapy. Today, she is not taking any medication and still remains in remission.
“I am forever grateful to everyone who has been so accommodating of my schedule so that I don’t have to live like a cancer patient every day of the week,” she says. “During all of this, I’ve worked on being my best advocate and enjoying each moment.”
Erlandsen’s experience on the trial was fairly unique, however: on average, there was about a 25% response rate to the drug combination. Researchers are still experimenting with sapacitabine and how it could be combined with other drugs, such as PARP inhibitors.
Completing a dream
Throughout her treatment, Erlandsen never stopped working as a high school math teacher. Despite the long drives to and from Boston, and the toll the therapy took on her body, she just couldn’t step away from her students.
In fact, there may be only one activity that can keep Erlandsen out of the classroom: skiing. This holiday season, the accomplished teacher and ski enthusiast completed a lifelong dream of working as a ski instructor at Pico Mountain in Vermont.
“Kirsten is a unique, resilient, and simply amazing individual,” Tolaney says. “She understands what she is up against but is constantly living her life throughout this.”
“Dr. Tolaney has always been straight with me, and treated me as a partner in my care,” adds Erlandsen. “She is honest about the limitations of current medicine while still giving me hope for the future.”