Patient Care News
'It's all about my patients'
Ellie Guardino, MD, PhDAlan Yatagai, photographer
When Jennifer Nolan Lyon got married, she eschewed gifts of crystal and silver and instead asked wedding guests to support breast cancer vaccine research at Stanford. This was a way the committed, “cause-based” marketing strategist could thank Ellie Guardino, MD, PhD, the oncologist who’d treated Jennifer’s breast cancer two years earlier. In the laboratory, Guardino is developing vaccines to treat and prevent aggressive, high-risk breast cancer.
Jennifer was diagnosed with breast cancer at age 32. She had no family history of breast cancer. Her tumor was discovered purely by chance, during a checkup for what she’d thought was a pulled muscle.
“Breast cancer certainly wasn’t part of my equation. My career had taken off, and I’d just fallen in love.” Jennifer says.
It’s popularly believed that younger women don’t get breast cancer. While it’s true that breast cancer affects a lower percentage of women younger than 40, it is still the leading cause of death in women ages 15 to 54.
Get the patient back into her life
A few days after receiving the news, Jennifer came to the Stanford Cancer Center, where she met Dr. Guardino and the team of surgeons, radiation oncologists and other specialists who would treat her breast cancer.
Jennifer had a mastectomy, followed by chemotherapy, radiation and hormonal therapy. She received genetic counseling and went through fertility preservation. Guardino guided the treatment plan, which emphasized both physical and emotional wellness, including nutrition counseling and participation in support groups and physical and relaxation therapy.
“As a physician, my goal is to get the patient back into her life,” Guardino says. “Yes, treatment includes understanding the biology of the tumor in order to eliminate it. But I also must know the patient to ‘keep her whole’ through chemotherapy, targeted therapy and five years of hormonal therapy. That means embracing her as an individual and appreciating the complexity of her relationships and support systems.”
Jennifer’s boyfriend, Ashley (now her husband), accompanied her to every appointment. “A different man might have said ‘I didn’t sign up for that,’ but the experience brought us together.” The couple became close to Guardino, who they called “the bright light around us.”
‘Educating’ the immune system
Guardino’s devotion to her patients drives her intellectual curiosity in the laboratory, where she is exploring the use of biologic treatments, including immunological approaches and recombinant gene therapy, for early, high-risk breast cancers and for advanced breast cancer. She currently is conducting a clinical study of a vaccine against HER2-positive breast cancer that has metastasized (spread).
Up to 30 percent of human breast cancers are associated with an overabundance of the HER2/neu cell surface receptor protein, which continuously “tells” the cancer cell to grow, resulting in an aggressive disease that is difficult to stop.
There is evidence that some women who have metastatic breast cancer have defects in their immune system, suggesting that they lack the normal immune “surveillance” against cancer. These immune deficiencies are also likely to contribute to breast cancer recurrence, Guardino says.
Guardino’s group is using a vaccine for advanced, high-risk breast cancer that delivers an excess of the HER2 target molecule to generate a robust immune response – or “educate” the immune system to recognize and destroy breast cancer cells as they arise. Studies she does in the laboratory examine the protective immune response that is generated after vaccination. She hopes to expand the study to include early-stage breast cancer to prevent recurrence or metastasis.
In collaboration with Stanford immunologists, Guardino will identify deficiencies of the immune system that result in breast cancer development or recurrence and demonstrate the vaccine’s ability to overcome these limitations. She hopes that the vaccine eventually will be used to prevent this aggressive, high-risk type of breast cancer, and that the approach might be used to develop other vaccines to treat and prevent other types of breast cancer.
Giving something back
Because of her experience at Stanford and the relationship she developed with Guardino, Jennifer Nolan Lyon has become an activist for breast cancer survivorship and vaccine research.
“How do you thank the people who changed your life? By changing the way for others. By telling everyone whose life has been touched by breast cancer. That means all of us. By being here, I can be part of something much bigger than breast cancer – preventing it,” Jennifer says.
Trial Administration