Amy Conlon arrived at Mayo Clinic's Rochester campus in August 2016 without much hope. The 35-year-old breast cancer patient and mother of three envisioned a grim future for herself. She imagined that future would include a mastectomy and a year's worth of chemotherapy and radiation therapy to fight off the stage 4 malignancy that had spread to her bones.
"Given the time I'd spent with other health care professionals, I was like, 'Oh, my gosh. This guy has given us his whole day,'" Amy says. "He was so thorough and gave us so much information. And the best part about it was that he truly got to know me and my family, and what would be best for my situation to determine my exact treatment plan. That's what impressed me the most."
And the treatment plan developed for her by Dr. Goetz, who leads Mayo Clinic’s Breast Cancer Research group and is a member of Mayo's Breast Clinic, looked nothing like the traditional plan Amy thought she was going to go through. Instead, it included an oophorectomy to remove her ovaries and two pills: one that lowers estrogen and one that prevents resistance to estrogen-targeting medication.
There was no mastectomy. There was no infusion chemotherapy, and there was no radiation therapy. And just one year later, there is no cancer.
"At Mayo Clinic, our most important goal is to provide a customized treatment plan that is based on a deep understanding of the biology of the breast cancer, as well as additional personal factors that may alter drug response," Dr. Goetz says. "We're going to recommend treatment designed for you and customized for you that we expect to work."
Discovering she had metastatic breast cancer was devastating, says Amy, who had an 8-month-old, a 5-year-old and a 9-year-old at the time of her diagnosis. But Dr. Goetz offered her a different perspective.
"As Dr. Goetz pointed out, people view stage 4 as a death sentence. But all stage 4 means is that the cancer has spread," Amy says. "There are various places where it could've spread, and mine went to my bones. If it had gone to my organs, we might have been talking about a different thing."
Physicians on Mayo's breast care team strive to offer their patients customized care tailored to fit their needs.
"We try to match the right patients to the right therapies," Dr. Goetz says. "When patients come to me, my goal is to figure out what are the characteristics that allow me to try to individualize the therapy for them."
The defining characteristic of Amy's cancer was that it was dependent on estrogen. Drugs that target estrogen, such as tamoxifen and aromatase inhibitors, are considered a standard treatment for estrogen receptor positive breast cancer. But their benefit is limited, and breast cancer cells develop mechanisms to grow despite inhibition of estrogen, Dr. Goetz explains.
That's where cyclin-dependent kinase 4/6, or CDK4/6, inhibitors come in. By blocking resistance to estrogen-targeted drugs, these inhibitors lead to higher tumor response rates and longer periods of cancer remission.
Another measure against the cancer is an injection Amy gets every three months to harden her bones. This works to prevent bone weakness and fractures, and helps keep the cancer from spreading. After just six months, Amy's cancer receded significantly. Today, she enjoys a complete remission.
The fact that her cancer has disappeared is amazing, Amy says. But the success of Amy's treatment, which she will continue receiving until it is no longer effective, isn't as surprising to Dr. Goetz.
"We are experiencing a new era in medicine, and within oncology in particular, where the pace of new knowledge and the integration of genomics into our practice have rapidly changed the way we practice. Practicing oncology in 2017 requires a deep understanding of the biology of the cancer," Dr. Goetz says. "That deep understanding translates into knowledge that affects the outcome for the patients."
Her physicians' insight and the minimal impact treatment has had on Amy's life — she's experienced only some hair thinning and mouth sores — has made her journey all the more remarkable.
"Their knowledge is absolutely amazing," Amy says. "They put themselves out there to learn the next treatment, cure. It's not just enough to say, 'We have what's out here now.' They do better. They're constantly thinking about the next best thing."
And Mayo providers do all this while developing personal relationships with their patients, Amy adds.
"There are many people who go through that place on a monthly basis," Amy says. "And to know they care about you and your family, that is nothing short of amazing.”