CLEVELAND — Since 1988, Mary Smrekar has been a nurse practitioner in gynecologic oncology at the Cleveland Clinic.

She always had empathy for her cancer patients, but ever since her own breast cancer diagnosis, she said she can relate to those she helps treat on a personal level.

“It’s a lot of information for a layperson to digest,” one of her patients said.

What You Need To Know

  • A major breakthrough in breast cancer research was announced this summer and since then, patients outside of the national study have been benefiting from an additional treatment option

  • A clinical trial found that HER2-low metastatic breast cancer patients who have undergone standard chemotherapy respond to a drug that previously was thought to only help HER2-positive patients

  • A Cleveland Clinic nurse practitioner who has breast cancer participated in the trial

“It’s a lot of information for a medical person, even as well,” Smrekar replied.

Smrekar said talking with someone who understands can provide comfort on both sides.

“I’m happy to know what I know,” Smrekar said. “But sometimes I wish I didn’t know so much. I give myself a lot of anxiety.”

Smrekar was diagnosed with stage two HER2-low breast cancer in 2010.

According to the American Cancer Society, HER2 is a protein that causes breast cancer cells to grow quickly. Higher levels of the protein are present in about 20% of breast tumors. For HER2-low patients like Smrekar, there have historically been fewer targeted therapy options. 

12 years ago, she had a mastectomy and was treated with chemotherapy and radiation. 

The nurse practitioner knows her experience is similar to the one in eight women in the United States who develop breast cancer in their lifetime.

“Breast cancer is so common,” Smrekar said. “It’s kind of like when is it going to be my turn?”

Smrekar had no recurrence for a decade and thought the worst parts of her battle with the disease were behind her.

During a gynecologic exam in 2020, she was surprised to learn something was wrong. Smrekar had a pelvic ultrasound and an MRI.

“And it came back showing a mass and it kind of looked liked cervical cancer, which is what I deal with, so it was a very strange kind of thing that was happening,” Smrekar said. “So, I did have a biopsy and, you know, breast cancer does not typically metastasize to the pelvic area, but it did.”

This time it was metastatic triple negative breast cancer, a more aggressive form than her initial diagnosis.

(Spectrum News 1/ Micaela Marshall)

Although she said she was scared, her medical knowledge helped her cope.

Smrekar, a wife and mother, was most concerned about her family.

“I felt worse for them,” Smrekar said. “I felt like I needed to be strong for them.”

Smrekar said the chemotherapy was causing her to feel extremely weak, and it did not seem to make a difference in terms of shrinking the tumor.

In June 2020, she was encouraged to take part in the DESTINY-Breast04 clinical trial.

The randomized study compared standard chemotherapy with an HER2 antibody-drug conjugate. The drug’s brand name is ENHERTU.

Before the trial, ENHERTU was FDA approved for HER2-positive patients only.

Dr. Halle Moore, Director of Breast Medical Oncology at the Cleveland Clinic, explained that because of the study’s promising results released this summer, this form of targeted chemotherapy is now an approved treatment option for HER2-low breast cancer.

The trial found ENHERTU controlled the cancer for longer periods of time and improved survival rates when compared to those who received standard chemotherapy.

“One of the greatest advances that we’ve had in the management of advanced breast cancer has been targeting the HER2 protein in HER2-positive disease. This for the first time showed that targeting that same protein in HER2-negative disease can actually achieve some of these great outcomes that we’ve seen only restricted to HER2-positive disease,” Dr. Moore said.

Smrekar is an example of those great outcomes. 

“The tumor initially shrank quite a bit. At least 30%,” Smrekar said.

She said her quality of life has improved dramatically since joining the clinical trial.

Smrekar was thrilled to be well enough to attend and enjoy her daughter’s wedding in August. There was a time when she thought she wouldn’t be able to make it to the big day.

“I’ve been traveling. I’ve been able to participate in the wedding like I wanted to. I continue to work. I just have been able to live my life,” Smrekar said.

Her entire career, Smrekar, has told others about the benefits of clinical trials. She’s thankful she’s now able to show her patients first-hand what’s possible if you participate.