Langley Perer thought her breast cancer was in the rearview mirror. In 2017, she had received a shocking diagnosis at age 35 of ductal in situ carcinoma (DCIS), the earliest form of breast cancer.
“As far as I knew, I had no family history of breast cancer,” she says.
DCIS is sometimes referred to as stage 0 cancer, non-invasive breast cancer, or pre-cancer; these terms all mean the same thing. However, Perer was treated with a double mastectomy — a surgical procedure used to treat breast cancer that involves the removal of the breast — in Los Angeles, since her physicians found that she was positive for a mutation on her BRCA gene. This meant she has a higher chance of developing a new breast cancer.
However, in 2020, Perer started to feel generally unwell. She visited a gamut of physicians who could not give her an answer.
“I consider myself a healthy person,” she says. “I eat healthy and take exercise seriously.”
A year passed and while out with friends on Martha’s Vineyard, Perer realized that her left eye was drooping.
“A friend pointed it out to me,” she laughs. “They said, ‘Do you have a lazy eye I never noticed?’ And of course, I said, ‘How dare you? What are you talking about?’”
An optometrist told her that it was most likely a stye that would resolve itself, but it didn’t. Instead, Perer’s vision started to get blurry in her left eye and she developed severe headaches. Realizing the potential severity of the situation, Perer and her husband left the island to see an ophthalmologist.
There, Perer received another shock; a magnetic resonance image (MRI) of her brain revealed several abnormalities.
“It was hard to understand,” she remembers. “I was told that, by definition, my breast cancer wouldn’t spread.”
Another biopsy confirmed the diagnosis: Perer’s breast cancer had metastasized to her brain.
Targeted therapy at Dana-Farber
With the help of her family, Perer began researching to determine where she wanted to go for treatment. She says all signs were pointing to Nancy Lin, MD, director of the Metastatic Breast Cancer Program and the Program for Patients with Breast Cancer Brain Metastases at Dana-Farber.
Everyone she asked, from physicians to friends and family, said that Lin and Dana-Farber’s program would be equipped to handle Perer’s case.
Further imaging at Dana-Farber found that Perer’s cancer had spread to her bones, and in a part of the brain called the leptomeninges. This complication — called leptomeningeal disease (LMD) — is rare, but often devastating.
“Small lesions in the brain can cause considerably worse symptoms than in other parts of the body,” Lin explains.
Research around the disease is lacking compared to others. Patients with LMD are often not included in clinical trials since they are often very sick. The standard treatments of brain radiation or chemotherapy instilled into the spinal fluid have not changed in 30 years, and comes with many potential complications.
However, Lin and her team have extensive experience treating patients with brain metastasis LMD and believed that Perer’s specific cancer might respond to a poly (ADP-ribose) polymerase inhibitor, or PARP inhibitor. Testing in Los Angeles revealed that Perer had inherited a mutation of the BRCA gene, which normally repairs DNA. The mutation means that some cells can’t repair DNA properly. PARP can often compensate for the loss of BRCA and allow heavily damaged cells to continue living and accumulate. A PARP inhibitor stops this process and causes these mutated cells to die off while allowing healthy cells to continue living.
Perer has been on the treatment for a year now. Scans have shown that her cancer is in check without progression, and some growths have started to shrink.
Lin says that Perer’s story has motivated her.
“It puts a face and a personal story to what is otherwise an abstract number,” she says. “We have to get this work done.”
Perer wants to ensure that she can survive to see her seven-year-old son and five-year-old daughter grow. “I will see my daughter graduate,” she says. “And watch my son play his first guitar solo.” He’s practicing Nirvana’s Smells Like Teen Spirit.