A Team Approach Tackles Rare, Aggressive Breast Cancer

Prima survived cancer thanks to her health partner’s team of experts, their access to hundreds of clinical trials, and their membership in the Memorial Sloan Kettering Cancer Alliance. Prima is now pursuing a career in oncology nursing.

Prima Duperval was enjoying a girls’ night out in August 2018, but behind her laughter she was worried about a walnut-size lump she’d recently discovered in her right breast. “I was a little in denial,” she says.

When she finally confided in her friends, they assured her it probably wasn’t serious. After all, she was just 31 with lots of energy and an exciting new job as a tech partner at Lehigh Valley Hospital–Cedar Crest. Still, they urged her to be smart and get it checked out.

Diagnosis shock

Duperval, who lives in Pocono Summit, Pa., made an appointment at nearby LVPG Obstetrics and Gynecology–Bartonsville. Results from an ultrasound and mammogram were inconclusive. Over the next week as she waited for her biopsy results, the lump began growing at an alarming rate.

On Aug. 13, Duperval and her mother arrived for the biopsy results appointment. The news was bad – the lump was a sarcoma, a rare form of aggressive cancer that can develop in soft tissues anywhere in the body. Duperval’s just happened to form in her breast.

“The advantage of being an Alliance member is that no matter how aggressive the cancer, we can bring groundbreaking precision medicine right to where patients live,” Dr. Nair says.

They immediately headed to Dale and Frances Hughes Cancer Center at Lehigh Valley Hospital–Pocono, where oncologist Suresh Nair, MD, with Lehigh Valley Topper Cancer Institute, had already been alerted. Breast cancer navigator Caroline McConnell, RN, was on hand to welcome them and answer questions from the moment they arrived.

“That day was overwhelming,” Duperval says, “but everyone was so supportive.”

Plan of attack

A positron emission tomography (PET) scan revealed that Duperval’s tumor had spread to nearby lymph nodes but not to her organs.

“At stage 3, we knew we had a shot at a cure,” Dr. Nair says. “But the tumor had already grown from 1 to 6 centimeters in under a month, so we had to move fast and treat it aggressively.”

To individualize her treatment, Dr. Nair enrolled Duperval in a leading-edge clinical trial to uncover genetic mutations driving the cancer – one of many innovations available to patients through the Cancer Institute’s membership in the Memorial Sloan Kettering Cancer Alliance (MSK Cancer Alliance).

“The advantage of being an Alliance member is that no matter how aggressive the cancer, we can bring groundbreaking precision medicine right to where patients live,” Dr. Nair says.

Genetic testing results showed that Duperval’s tumor cells had a BRCA1 (BReast CAncer) gene mutation, but the rest of her body’s cells were mutation-free, meaning she had no genetic risk factors for cancer. Encouraged by the results, her medical team agreed to treat the tumor as a sarcoma (not a traditional breast tumor) using highly targeted chemotherapy drugs to inflict maxi- mum DNA damage to the mutated tumor cells. Afterward, Duperval would undergo surgery and radiation.

Top-tier treatment

Between August and October, Duperval received two rounds of “continuous infusion” chemotherapy, both requiring a three-day hospital stay with round-the-clock intravenous treatments that drained her physically but effectively shrank the tumor.

On Oct. 17, Duperval underwent an elective double mastectomy with surgical oncologist Heiwon Chung, MD, with LVPG Surgical Oncology, followed by another chemotherapy round. Afterward, she began radiation therapy at Hughes Cancer Center where she received 30 radiation treatments.

Today, Duperval is cancer-free and recently enrolled in a nursing program. “If not for my medical team’s support I don’t think I’d be here,” she says. “I really want to give back now, and this experience has pushed me to become an oncology nurse.”