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I am really honored to be joined by Jessica Fioretti today, who is a patient who has Experienced ER positive, HER2 negative metastatic breast cancer, and we're really honored to have her share a little bit about her journey today. Thank you so much for joining us, Jess. Thanks, thank you for having me. Um, your journey didn't start with a metastatic diagnosis. Could you share what it was like to go from being an early stage survivor to then learning that the cancer had returned and was now metastatic? Sure. Um, yeah. So at 39 years old, I was diagnosed with early-stage hormone-positive breast cancer. Um, I went through all my surgeries. Um, I had double mastectomy. I went through treatments. Um, And I started, you know, some oral medications thinking I was kind of on the other side of things. Um, and then I had done everything that, you know, is gonna help prevent recurrence. Um, and then just shy of about 4 years, I felt a lump in my armpit. And I contacted my doctor and we went through all this, all the motions of having an ultrasound that required a biopsy that confirmed that I was having a local recurrence. Um, so I had really asked my breast surgeon to please give me a PET scan. Um, that wasn't the standard of care, um, you know, with my original diagnosis, so I had never had one before. Um, and she agreed. And so when I had the PET scan, they did discover that I had, um, metastatic lesion on my liver and met next to my, uh, some lymph nodes in my chest. Many patients in this situation are on a similar combination of endocrine therapy plus CDK46 inhibitor. Um, did you have issues with side effects from previous endocrine therapies, and what was the experience of living on a new combination been like in terms of managing your daily life and your hopes for its effectiveness? Um, yeah, I did have side effects from my prior, um, medications that I was on. I actually was, um, pre-menopausal when I started my journey. And, um, so I was on one medication and I was definitely having some side effects. There was a lot of joint pain. Um, I had a lot of muscle cramping, especially in my calves that would just wake me up at night in excruciating pain. Um, and then I went, um, I had a total hysterectomy, and then I went on a different medication for postmenopausal. Um, and then my side effects actually got worse. My bones were throbbing, um, and I just was so uncomfortable all the time. Um, in addition to having fatigue, um, and low energy throughout the day, I felt like my endurance really suffered. Um, And so my doctor actually put me back on the original medication. Um, And it seemed to be at least more tolerable than the postmenopausal medication. Um, But yeah, once I became metastatic, um, everything changed. And so now I get injections, uh, monthly. And the hormone blocker injections. And it's been OK. I mean, they, it comes with, you know, its own, you know, different, um, administration. Um, but, you know, overall, it's definitely been tolerable. I, I could actually say I feel better now than I did on the other medications before I was metastatic. Um, so it's, it's been for sure tolerable. Every patient is hoping for stability. Um, but you had a very challenging experience with monitoring, I believe, where an MRI for headaches. Picked up numerous lesions in your skull and spine that the PET scan, PET scan hadn't picked up. Can, can you walk us through what, what that journey was like and uh the roller coaster really of that discovery? Yeah, that was pretty devastating. Um, so I had, I had been diagnosed metastatic October of 2023 and around late May of, um, 2024, I was having some headaches, but I also have allergies. But, you know, once you're, once you're a cancer patient, everything worries you. So my doctor agreed, let's, let's do a brain MRI even if we just have it as a baseline, that it would be beneficial. So I had the test done and um I remember the, you know, results popping up in my portal and I was out to dinner with my family and I should not have opened. I should not have opened my results, but, um, I truthfully wasn't expecting to read what I read, and it said that I had innumerable mets to my skull. Um, and it was just a blow, like, am I having progression already? Are I, you know, are the meds that I'm on not working? Like, where do we go from here? What am I gonna do next? Um, And so it's a little comforting once we finally got to the doctor and he kind of put things into perspective for us, you know, he said, look, skull mets don't just appear either. They don't just start there. So it had to have traveled from somewhere. Um, and we need to determine where, you know, if there's anything on your spine, and then we can discuss what, what we need to do further. So that's what I did. I went and I had, um, a cervical, thoracic, and lumbar MRI. And that also um discovered that I had innumerable lesions all throughout my spine. Um. It also picked up on some lesions on my sacrum, my pelvis, my clavicle, and my ribs. Um, not as extensive, but they were there. And so, um, you know, I was just baffled, like, why didn't any of this show up on my PET scan? What, you know, how does that happen? To me, I thought PET scan was like the end all be all. Of everything. And they said, um, what happens is, is that if it's, if the lesions are too small or inactive, then it won't show on a PET scan. But because when you have lesions on your skeleton, they don't really disappear. I guess they'll always be there whether they're active, you know, even when they're not active. So I went back to my doctor cause now I was like, oh my gosh, it's everywhere. And he said, you know, It's baffling because it wasn't showing on the PET scan and it wasn't showing on a bone scan. And so he said, you know, what they kind of believe is that because I had started my medication right away, that it was treated meths to my spine and my, you know, skull and all that, and that's why they're so small and that's why they're inactive. So the course of treatment actually stayed the same. He said, let's just keep going uh on what you're doing and see how things go. And so, That was June of 2024. And I just had um scans last week on my skull and my spine, and everything has been stable. So I'm happy about that. And we're just continuing on with that course of treatment. I'm waiting for, you know, my PET scan and um, It's just, you know, kind of where we're at right now as far as treatment goes. Um, I mean it's a really important example of clinical complexity and the journey that both doctors and patients have to navigate. How important was your doctor's communication in helping you understand. The decision of staying the course rather than switching therapies. Um, it was very important. I mean, I, I did have, uh, I did have to go through a sacral biopsy cause they did wanna make sure that my cancer didn't mutate and that this wasn't a different type because that often happens when you have, um, breast cancer that metastasizes. It can change from your original diagnosis. And so he wanted to Also have that taken care of to make sure, like, do we, you know, to help guide him, I guess, in, in where we're gonna go with this. And so I had the sacral biopsy done and it was just not enough um of a sample. And it was really inconclusive. Almost, you know, they almost made it sound like it was negative for cancer, which was also baffling. And um the radiologist is baffled. My oncologist is baffled. Um, But you know, all those things really are needed to determine like what the best next course of treatment is. And so for him to be able to communicate with the radiologist and to really kind of get that full picture um is helpful because, you know, while I know there are other lines of treatment out there, I appreciate that he wanted to kind of Maybe, you know, stay on this first line and just kind of make sure. Since this was new information, let's just make sure. I think we did do a scan sooner than the typical 3 months just to kind of watch for that progression. Um, and so once he, once we saw that it was stable, he felt comfortable staying on, you know, the current course of treatment, and I've been on that ever since. And your experience highlights the importance, that shared decision making. Um, um, while your current therapy.