When Denise Murray found a lump on her breast in January of 2016, she was not immediately concerned. After all, people find lumps all the time that are benign. And, she had already survived a battle with lymphoma at age 13. Unfortunately, after several tests, Denise was diagnosed with breast cancer and found herself on a cancer journey for the second time in her life.

Denise's childhood oncologist from Children's Hospital of Philadelphia referred her to Angela DeMichele, MD, MSCE, Alan and Jill Miller Professor in Breast Cancer Excellence. At age 30, Denise and her husband John Ball were concerned that harsh treatments would hinder their chances of starting a family. Her circumstances were further complicated by her childhood lymphoma therapies.

Denise underwent a lumpectomy, and Dr. DeMichele designed an alternate treatment plan of chemotherapy and radiation that factored in her previous treatments and avoided fertility complications. Dr. DeMichele also worked closely with Clarissa Gracia, MD, MSCE, Fertility Preservation Program Director, to ensure that Denise would have options for having a family in the future.

"Dr. DeMichele tailored everything to my life, my cancer, and my future plans. She supported my every decision from continuing to teach high school math to coaching field hockey. Her focus was always to make the best decisions possible without uprooting my life," Denise explained.

Denise's care team extended beyond Philadelphia through Penn Medicine's wide network of satellite locations. She received her diagnosis at Virtua Health, devised a treatment plan at the Perelman Center for Advanced Medicine, had surgery at the Hospital of the University of Pennsylvania, and was then able to receive chemotherapy treatments at Penn Medicine Cherry Hill. The fact that all of these options and locations were available to her within the same cancer center made a huge difference for Denise throughout her treatment.

Another source of comfort and confidence was Dr. DeMichele who, like so many oncologists at the ACC, not only treats patients but also leads advanced research efforts. Penn's 2-PREVENT Translational Center of Excellence, led by Dr. DeMichele and Lewis Chodosh, MD, PhD, is the first center dedicated solely to breast cancer recurrence. The Center works to provide additional targeted therapy and clinical trials to patients at risk for relapse so they become—and remain—cancer-free.

Denise completed her treatments in April 2016. Immediately afterwards, she opted to enroll in the PENN-SURMOUNT screening study and have her bone marrow tested for disseminated cancer tumor cells (DTC). DTC's are thought to survive primary therapy, travel to the bone marrow where they can remain in a dormant state for years, and then potentially give rise to a recurrence. Denise's results were positive for DTCs and she was offered enrollment in the CLEVER trial. This phase II pilot trial administers hydroxychloroquine (HCQ), everolimus (EVE), or the combination of the two to prevent recurrent breast cancer.

Six months out of the CLEVER study, Denise is doing remarkably well and her bone marrow tested free of DTCs. Denise is incredibly grateful: for her team's preservation of her fertility, for Penn's multiple locations that helped make life during her treatments manageable, and for the extra peace of mind Dr. DeMichele and the TCE's studies have given her and her husband.

Denise's outlook remains positive and hopeful for the progress that she has seen since her first battle with lymphoma, over 10 years ago. And with hope comes power, "You don't know how strong you are, until being strong is your only option," said Denise.

Research Fuels Hope

Designed to holistically address breast cancer recurrence, the 2-PREVENT TCE brings science and care full circle, from surveillance and prediction to recurrence and prevention.

SURMOUNT: A surveillance study for women with non-metastatic breast cancer, who are within five years of their original diagnosis. Patients are screened for disseminated tumor cells (DTCs) in the bone marrow, and if DTCs are found, are given the option of enrolling in additional studies to prevent recurrence.

CLEVER: This recurrence prevention study offers a novel drug combination designed to eliminate DTCs. During the course of this trial, patients undergo additional bone marrow assessments at three and six months to ensure they are clear of DTCs.

GLACIER: Similar to CLEVER, this study also offers a novel drug combination to prevent recurrence, and in addition samples are also collected to provide insight into the properties of DTCs.

METAMORPH: This study collects tumor samples of patients with advanced or metastatic disease, who have suspected or confirmed recurrent, metastatic breast cancer. In collaboration with Penn's Center for Personalized Diagnostics, samples go through genomic profiling to better understand and track molecular and genetic changes that occur as an individual's disease progresses.