The Importance Of Education And Open Conversation On A Breast Cancer Diagnosis

A normal day at work soon became one of the most life-altering moments of 57-year-old Cathy's life. After having a routine mammogram followed by a biopsy, Cathy received the call from her doctor that she had Stage II HER2-positive breast cancer. HER2 — or human epidermal growth factor receptor 2 — is a protein that causes cells in the body — both normal cells and cancer cells — to divide and grow. In HER2-positive breast cancer, too much HER2 is present, and this may cause the cancer cells to grow more quickly and form a tumor.

“I felt very overwhelmed. There were a lot of follow-up tests and people calling me left and right to schedule appointments. There was so much information, and I didn’t know what everyone was going to do, but I knew I had a team,” Cathy says.

Thankfully, Cathy had an oncologist she could trust and confide in, Dr. Ahmed Elkhanany, an assistant professor of medicine in the Division of Hematology and Oncology at the University of Alabama at Birmingham. Dr. Elkhanany walked her through every step of the process, and explained how her condition was going to be treated. “He listened to me. I appreciated the way he spoke to me. I appreciated how much time he spent to make sure I was comfortable in knowing what he knew at the time, and what the best plan of action was,” Cathy says.

For Black women like Cathy, breast cancer death rates are 41% higher compared to White women. In fact, Black women have a lower survival rate at every stage of the disease. Although the death rate of women with breast cancer declined 42% between 1989 and 2019, we cannot forget the fine print: not all women have benefited equally from the advances and progress in women’s health in recent years. One reason for these disparities is the inability to access high-quality cancer care. Black women are more likely to be screened at low-resourced and non-accredited facilities and have a longer wait time between mammograms and follow-up exams after receiving an abnormal result.

Along with lack of access to care and social, economic and cultural barriers comes a variety of other factors affecting this rate including but not limited to mistrust of the healthcare system and misinformation. For many minority and medically disenfranchised patients, being taken seriously and trusting their doctor is an important aspect of their care.

Knowing these concerns, Dr. Elkhanany focuses on building trusting relationships with his patients like Cathy, “with education and good honest conversations.” One of the most difficult parts of a breast cancer diagnosis is when patients are first diagnosed, and they’re not sure what is going to happen. For Cathy, it didn’t matter what challenges she faced during her journey, she was persistent and comfortable in asking questions, educating herself, and holding tight to her faith.

Cathy started a pre-surgery treatment regimen of chemotherapy plus HER2-targeted therapy. She received chemotherapy weekly, but every three weeks she would go into a treatment center and spend one to two and a half hours receiving intravenous (IV) infusions of her HER2-targeted therapy through a port implanted in her chest. “I want to see how you do with the initial infusion of targeted therapy, and if everything goes well, I want to suggest a treatment option of an injection that is administered in your thigh,” Dr. Elkhanany told her. After 12 weeks, Cathy completed her pre-surgery treatment plan and received a lumpectomy (removal of a tumor from the breast).

Although her diagnosis was scary, Cathy trusted her medical team and didn’t hesitate when Dr. Elkhanany suggested she switch to Phesgo® (pertuzumab/trastuzumab/hyaluronidase-zzxf), an injectable option that combined two of the IV medicines that she was already receiving.

Dr. Elkhanany explained that unlike most HER2-targeted therapies administered through an IV infusion, Phesgo is a subcutaneous injection given under the skin by a healthcare professional. It is approved by the Food and Drug Administration for use in combination with chemotherapy before surgery as part of a complete treatment regimen for HER2-positive early breast cancer, and after surgery in adults with HER2-positive early breast cancer that has a high likelihood of returning.

Cathy and Dr. Elkhanany discussed the benefits and risks associated with Phesgo, including the most serious potential side effects, such as heart and lung problems. Although Cathy was not pregnant when she was diagnosed and started treatment, she was advised about the risks Phesgo poses to pregnant women. Use of Phesgo in pregnant women may result in serious risks to the unborn baby, including death and birth defects. More important safety information can be found below in this article.

Every three weeks, Cathy would go into the clinic to receive Phesgo. The injection was given just under the skin of the thigh and took approximately five minutes (the initial dose took approximately eight minutes) to administer, and Cathy would sit for 15-30 minutes afterward while she was monitored for any reactions. With the support of her work team throughout her treatment, she was able to receive her injections at the end of the work day. Because for Cathy, being able to continue work was an important aspect of life she didn’t want to lose. “Dr. Elkhanany assured me that he has had patients who were able to work during their breast cancer treatment, and I wanted to try to be one of those people because I enjoy what I do,” Cathy says.

This past March, Cathy completed the recommended 18 cycles of HER2-targeted therapy and was able to ring the bell. “It's a blessing to be at this stage in my journey, being able to continue in a positive manner, and do what I need to do to keep pressing on,” Cathy says. She is thankful for everyone who has stood by and supported her through this journey. “I’m blessed to be in this position, and it seems like this past year has gone by so fast. At the onset, that felt like a lifetime away.”

To learn more about advances in breast cancer treatment and other breast cancer types, visit Genentech’s Breast Cancer Hub.

Phesgo Important Safety Information & Uses

What does PHESGO treat?

PHESGO® (pertuzumab, trastuzumab, and hyaluronidase-zzxf) is a prescription medicine approved for use in combination with chemotherapy for:

• Use prior to surgery (neoadjuvant treatment) in adults with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (tumor is greater than 2 cm in diameter or node-positive). PHESGO should be used as part of a complete treatment regimen for early breast cancer.
• Use after surgery (adjuvant treatment) in adults with HER2-positive early breast cancer that has a high likelihood of coming back.

What should I know about side effects with PHESGO?

• Not all people have serious side effects; however, side effects with PHESGO therapy are common. It is important to know what side effects may happen and what symptoms you should watch for.
• Your doctor may stop treatment if serious side effects happen. Be sure to contact your healthcare team right away if you have questions or are worried about any side effects.

What are the most serious side effects of PHESGO?

PHESGO may cause heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure).

• The risk for and seriousness of these heart problems are highest in people who received both PHESGO and a certain type of chemotherapy (anthracycline).
• Your doctor will check for signs of heart problems before, during and after treatment with PHESGO. Based on test results, your doctor may hold or discontinue treatment with PHESGO.
• Contact a healthcare professional immediately for any of the following: new onset or worsening shortness of breath, cough, swelling of the ankles/legs, swelling of the face, palpitations, weight gain of more than 5 pounds in 24 hours, dizziness or loss of consciousness.

Receiving PHESGO during pregnancy can result in the death of an unborn baby and birth defects.

• Birth control should be used while receiving PHESGO and for 7 months after your last dose of PHESGO. If you are a mother who is breastfeeding, you should talk with your doctor about either stopping breastfeeding or stopping PHESGO.
• If you think you may be pregnant, you should contact your healthcare provider immediately.
• If you are exposed to PHESGO during pregnancy, or become pregnant while receiving PHESGO or within 7 months following the last dose of PHESGO, you are encouraged to report PHESGO exposure to Genentech at 1-888-835-2555.

PHESGO may cause serious lung problems.

Your doctor may check for signs of lung problems including:

• Severe shortness of breath
• Fluid in or around the lungs
• Weakening of the valve between the heart and the lungs
• Not enough oxygen in the body
• Swelling of the lungs
• Scarring of the lungs

Who should not receive PHESGO?

• PHESGO should not be used in patients who are allergic to pertuzumab, trastuzumab, hyaluronidase, or to any of the ingredients in PHESGO.

What are other possible serious side effects?

• PHESGO may worsen low white blood cell counts caused by chemotherapy: Low white blood cell counts can be life threatening and were seen more often in patients receiving Herceptin® (trastuzumab) plus chemotherapy than in patients receiving chemotherapy alone. Your doctor may check for signs of low white blood cell counts when he or she examines you.
• PHESGO may cause administration-related reactions: PHESGO is given as an injection. The active ingredients in PHESGO have been associated with severe administration reactions, including hypersensitivity or anaphylaxis, which can be fatal. Talk to your doctor if you feel any symptoms. The most common symptoms include dizziness, nausea, chills, fever, vomiting, diarrhea, hives, swelling of the skin, breathing problems, or chest pain.

What are the most common side effects?

The most common side effects of PHESGO when given with chemotherapy as part of an early breast cancer regimen are:

• Hair Loss
• Nausea
• Diarrhea
• Low levels of red blood cells
• Weakness

You are encouraged to report side effects to Genentech and the FDA. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at1-888-835-2555.

Talk to a healthcare professional for more information about the benefits and risks of PHESGO.

Please see full Prescribing Information for additional Important Safety Information, including most serious side effects.

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