When Emma Mon learned the breast cancer she’d been diagnosed with as young mother had returned and spread to her lungs, she feared her time was running out. But that was five years ago, and since then, she’s been living her life with metastatic breast cancer.
It has not been easy. But she just celebrated a milestone she’s been dreaming of since she was first diagnosed: college drop-off day for her son, Peter. Standing on the campus of Purdue University, she said, “I am so lucky to be here. There will be a lot of tears today. But I made it.”
Peter and his sister, Lexi, were just toddlers when their mother was diagnosed with stage 2b ER+ / HER2- breast cancer at age 34. With her husband, Bill, by her side, Emma eventually recovered after a double mastectomy and chemotherapy. A decade later, she was running marathons and raising two teenagers. Emma’s job had moved them from Pennsylvania to New York City, where her career as an executive for a global corporation had taken off.
Breast cancer was in her rearview mirror, she thought. “I had a really long stint of no evidence of disease.”
Then one day in 2018, Emma felt a lump in her side. Doctors at a New York area hospital downplayed her concerns, but she pushed for more testing. A surgical biopsy confirmed that it was, in fact, breast cancer that had spread beyond the chest wall. More testing revealed that the original breast cancer had spread, or metastasized, to her lungs.
Her goal was to find the best place for treating metastatic breast cancer. She called Memorial Sloan Kettering Cancer Center. “The biggest thing I’ve learned over the years of my cancer journey is to be my own advocate,” she says. “I came to MSK after being my own advocate.”
A New Era for Treating Metastatic Breast Cancer
“As soon as I met her, I knew I made the right call,” Emma says. “She spent time answering all my questions. She was so empathetic — but also, very clear in what she wanted to do.”
One of the first things Dr. Singh makes clear to all her patients is that metastatic breast cancers are treatable and there are new medical reasons for hope — including a drug approved by the FDA this year for some ER-positive, HER2-negative breast cancers, and a drug approved in 2022 for HER2-low cancers. Many more are in the pipeline, and new tests can guide the best treatment. Each metastatic breast cancer patient’s case is unique, based on the patient’s age and overall health, on the cancer’s subtype, and on tumor biology.
“I think the biggest misconception about metastatic breast cancer is that people feel it’s the end of life,” Dr. Singh says. “The landscape has changed remarkably over the last few years because we have so many new treatments. The progress that’s been made in this field is tremendous and makes me very optimistic about our ability to manage stage 4 breast cancer now and in the future.”
Still, Dr. Singh is careful to balance the whole picture. “I don’t want to minimize the fact that our stage 4 patients often need regular monitoring in the form of CT and/or PET scans and may need to be on treatments indefinitely, which may lead to some side effects,” she says. “Despite that, many are living full lives; they are continuing to work, travel, exercise, and spend time with their families.”
Stage 4 Breast Cancer vs. Earlier Stages
Metastatic breast cancer, also known as stage 4 cancer, is cancer that has spread outside the breast to other organs such as bones, liver, lungs, or brain. So, under the microscope, the cells in Emma’s lung tumor looked and acted like breast cancer and needed to be treated as breast cancer.
Treatment of metastatic breast cancer is lifelong and focuses on preventing further spread of the disease, along with managing symptoms so people can feel as good as possible for as long as possible. Many clinical trials at MSK are testing new treatments.
“With current treatments, we sometimes see complete responses…cancer disappearing completely on scans in some patients. These responses are sustained for long periods,” Dr. Singh says.
The type of breast cancer Emma has is hormone positive, HER2 negative. Dr. Singh prescribed her hormone therapy with a once-daily pill, palbociclib, a CK4/6 inhibitor, in combination with fulvestrant, an estrogen-blocking drug that is delivered in a once-a-month injection. It’s not chemotherapy. It puts the brakes on the growth of cancer by blocking an abnormal protein that signals cancer cells to multiply.
Partners in Survival
For five years, hormone therapy kept Emma’s metastatic breast cancer stable. She watched her children grow up and become teenagers. She continued to do the work she loved, and she traveled the world. She hiked with her beloved Bill in Utah’s Zion National Park.
As new symptoms have arisen, Dr. Singh has modified Emma’s medications and added other MSK specialists to the team. Radiation oncologist Melissa Zinovoy, MD, treated Emma’s shoulder bones with focused radiation, which successfully eliminated some discomfort Emma had been weathering.
Last December, a scan showed the cancer had metastasized to Emma’s brain. The physical and emotional effects of “brain mets” can be wide-ranging and devastating. It’s a new chapter in the disease. “The thought of something I can’t control worries me a lot,” Emma says. “I just have to take one step at a time.”
Within days, Emma’s MSK team was expanded to coordinate neurological treatment with surgery, radiation, and drugs.
- Neurosurgeon Nelson Moss, MD, who specializes in brain tumors, operated on Emma before Christmas. He leads MSK’s unique Multidisciplinary Brain Metastasis Clinic.
- Dr. Zinovoy treated her brain with radiation.
- Neuro-oncologist Jacqueline Stone, MD, who specializes in the care of people with brain tumors and the neurologic complications of cancer, became a crucial member of the team.
- If Emma needs help coping with the emotional pain and stress, there are support groups specifically for people with metastatic breast cancer.
Emma appreciates how seamlessly her MSK providers share notes on her care. “The best thing about it is everybody is connected,” she says. “So if something happens to me or something new pops up on a screening or an MRI, they talk about it collectively.”
Emma, now 49, credits this team approach for her survival, saying: “It’s an integrative approach where many doctors weigh in, which I think is invaluable and a key reason I’m still here. I have no doubt about that.”
MSK at the Forefront of New Treatments
In 2022, one of the most promising new advances in metastatic breast cancer, pioneered at MSK, made headlines when cancer specialists hailed it as “a new standard of care.” Medical oncologist Shanu Modi, MD, led a groundbreaking clinical trial that showed the drug, trastuzumab deruxtecan, halted cancer growth in some patients whose cancer had been progressing despite powerful chemotherapy.
Dr. Singh was a researcher working on the trial, the results of which expanded treatment options for thousands of patients. She is optimistic the drug — now approved by the FDA — could one day benefit Emma.
“So down the line, I do think Emma is going to be a candidate for that as well,” Dr. Singh says. “It’s just an intravenous treatment, given every three weeks. It’s very well tolerated. We have seen long-lasting disease responses and activity against brain metastases. I think it’s a wonderful addition to our armament.”
A Mother’s New Dream
It was college drop-off day in August 2023, and Emma, Bill, 18-year-old Peter, and 16-year-old Lexi were at Purdue University for freshman move-in.
Emma took a quiet moment to reflect in the empty stands in the football stadium, the goalposts rising behind her in the distance. It’s a fitting image.
“Life is made up of moments that matter,” she said in a video recording the happy occasion. “And this is a milestone that I’ve had on my goal list since 2008 — make it to my kids’ high school graduation and college drop-off. I didn’t know I would make it.”
Emma is keenly aware of how she wants to spend her time. She’s got a new focus. She wants to educate people about the need for more research into metastatic breast cancer (less than 7% of breast cancer research dollars go to stage 4 disease, according to the Metastatic Breast Cancer Alliance), and she’d like to dispel myths at work. “I watched how people talk about cancer in the workplace, and they count you out. Just because you’re diagnosed with stage 4, it’s not the end.”
In true Emma fashion, she continues to dare to dream big. “I’m not trying to overestimate my impact on what I can do. But I also don’t want to shoot too low.” As for her family, this mother has Lexi’s graduation next on her list and admits to one more dream for her future — to see her kids get married. “I would love to be a grandmother.”