If Jennifer Feinberg were to write a book, she would call it “There’s Always Something” — a saying that captures not only life but also her cancer journey.
“It started with my second-ever mammogram,” says Feinberg, who was diagnosed at age 41 and is now 49. “The radiologist near my home in Washington, DC, pulled me into a private room and said I had stage 0 breast cancer, or ductal carcinoma in situ (DCIS).”
In the beginning of 2018, Feinberg underwent a double mastectomy and reconstruction by her home to give her peace of mind. Following her surgery, her pathology report indicated a micro-metastasis of HER2-positive cancer — an aggressive breast cancer promoted by the human epidermal growth factor receptor 2 (HER2) protein. For her early-stage cancer, Feinberg pursued the most aggressive treatment option available and moved on.
“I did all the things I needed to do and didn’t require any further treatment at the time,” Feinberg says. “I thought everything was done and so I went the next two years thinking that the cancer was behind me.”
In 2020, Feinberg developed a persistent cough and couldn’t walk up a flight of stairs. While she thought it was COVID-19, it turned out her early-stage cancer had metastasized.
Feinberg received what was the standard of care regimen at the time, trastuzumab, docetaxel, and pertuzumab to target her HER2-positive cancer. For the next 18 months, Feinberg’s cancer was stable.
In 2021, her cancer spread to her brain. That’s when Feinberg and her doctor in Washington, DC, consulted Dana-Farber’s Nancy Lin, MD, associate chief of the Division of Breast Oncology and director of the programs for Metastatic Breast Cancer and Breast Cancer Brain Metastases.
“Brain mets are common in patients with HER2-positive metastatic breast cancer; 50% of patients will eventually experience spread of cancer to their brain,” Lin says. “Historically it is also difficult to treat because our nervous system has a natural protective wall called the blood-brain barrier that prevents drugs like chemotherapy from entering the brain.”
A Dana-Farber Experience
Feinberg wanted Lin on her team. Now, as a shared patient between her local doctor and Dana-Farber, Feinberg was ready for the next step. She joined the HER2CLIMB-04 clinical trial.
The trial evaluated tucatinib and T-DXd. Tucatinib is a pill that blocks the HER2 protein and can cross the blood-brain barrier to shrink brain metastases and improve survival in patients with HER2-positive breast cancer, as shown in the original HER2CLIMB clinical trial. T-DXd is an antibody-drug conjugate, a type of medicine where chemotherapy is attached to an antibody that targets treatment to tumor cells. As shown in the DESTINY-Breast12 study, led by Lin, T-DXd can also be effective against brain metastases.
After about 9 months of treatment in Washington, Lin and Feinberg pivoted. Ayal Aizer, MD, MHS, senior physician and director of the Central Nervous System Radiation Oncology, joined the team.
“Dr. Lin created a long list for me of all my options; we had a rhythm. I get my scans, consult Dana-Farber to evaluate my current treatment and then refer back to my team in Washington, and stay on my treatment as long as I can until the next one,” Feinberg says.
Since Feinberg was diagnosed with breast cancer brain metastases, she has undergone several treatments, such as stereotactic radiosurgery (a targeted brain radiation therapy), a drug combination of T-DM1 with neratinib led by Lin and Rachel Freedman, MD, MPH, a medical oncologist and researcher at Dana-Farber, and high-dose trastuzumab with pertuzumab. She is now back on trastuzumab as her tenth line of treatment.
“There are patients who respond well to treatment, but cancer is smart and can resist that first line of therapy,” Lin says. “For those who have metastatic breast cancer with brain metastases diagnoses, it can be difficult to find the right treatment, but that’s why the longer the list with the addition of the latest options, the better.”
Over the last eight years, Feinberg has seen more treatment options become available to her, including tucatinib, T-Dxd, and neratinib. Lin, Aizer, and other Dana-Farber researchers are leading new clinical trials for patients with breast cancer brain metastases which are testing ways to make tumor cells more sensitive to radiation and are testing new HER2-targeted pills such as IAM-1363 and ZN-A-1041 that slip through the blood-brain barrier more effectively than any current FDA-approved drugs.
The new early-phase trial will hopefully open by the end of the year and will test whether stimulating the immune system while targeting excess blood vessel growth might also provide benefit.
A Long Journey
When Feinberg was first diagnosed, her children were six and nine. Now, they are teenagers, which she never thought she would get to see.
“It’s been a long journey, but it’s pretty amazing I’m still here,” Feinberg says.
Just as Feinberg’s cancer and treatment has evolved, so has her desire to participate in the breast cancer community. During her treatment, she set up page through the Breast Cancer Research Foundation (BCRF) to tell her story and raise awareness.
“It was so empowering to do this,” says Feinberg, who has raised nearly $2 million dollars for HER2 research. “My voice in the community grew over time.”
As Feinberg’s fundraising efforts for improving outcomes for individuals with her cancer type gained traction, it turned out Lin would be the perfect recipient of her BCRF grant.
“When I was first diagnosed, I was looking for stories of hope, and now my story is being told, and I just hope others benefit from hearing my story,” Feinberg says. “I also want my girls to understand advocacy and to help other people understand and support research.”
Over the last few years, Feinberg has not only built an online community through her BCRF page, but she also joined a DC-based support group with other women diagnosed under 45 years old.
“As part of my plan, I try to stay as long as I can on my current therapy until the next combination because as I’ve gone through this process, more and more options are becoming available to me,” Feinberg says. “While life with cancer is hard, it is still a life I want to live — even if there is ‘always something’.”
Dana-Farber offers support groups by disease types like breast cancer and by need, such as for young adults.