Breast cancer survivor credits clinical trial for a second chance at life

Angela Silva, DBA, MAOL, CRA, has long known that research can save lives. As a certified research administrator, she has spent much of her career helping health professionals develop their research ideas, apply for funding and run their programs or clinical studies.

In 2019, while Silva was working at the MultiCare Institute for Research and Innovation, her life took an unexpected turn. She was diagnosed with an aggressive form of breast cancer, and in a matter of months went from managing clinical studies to participating in one.

“I was on the cusp of turning 50, and a cancer diagnosis was not how I envisioned starting this decade of my life,” she says. “But in some ways, looking back, I feel lucky. If I hadn’t been so research-oriented and had the benefit of participating in a trial close to home, I might have ended up on a very different path. Instead of being a survivor, I might be dealing with metastatic cancer right now.”

An unsettling discovery

Silva was getting ready to shower one August morning when she noticed dimpling (slight skin indentations) on her right breast. She made an appointment to get a mammogram but needed a diagnostic ultrasound instead.

Over the next several weeks, she underwent a series of tests and procedures that confirmed a diagnosis of triple-negative breast cancer. This type of cancer is fast-growing — in Silva’s case it had spread to her lymph nodes — and can have a poor prognosis.

“The standard treatment for triple-negative breast cancer is pre-operative chemotherapy usually followed by surgery,” says Nehal Masood, MD, a medical oncologist at MultiCare Tacoma General Hospital. “However, responses to chemotherapy can be unpredictable. Some people do well, but it’s also common for the cancer to reoccur within a few years and cause life-threatening complications.”

In conversations with research staff and Dr. Masood, Silva learned that a clinical trial testing an immunotherapy — a type of drug that boosts the immune system’s ability to fight cancer — may help her achieve better long-term results than standard treatment alone, and the trial was offered through the very place she worked: the MultiCare Institute for Research and Innovation.

“This trial was going to give me my best shot at living into my 50s and beyond,” she says. “Plus, it was local. I could still work and live my life, as best as possible, while participating in this study. I knew that I was in the best hands.”

Beyond the standard of care

Clinical trials have different phases, each with their own purpose. Silva enrolled in a phase 3 trial. By this phase, a new treatment has already demonstrated effectiveness in people through previous rounds of testing.

What investigators want to know in phase 3 is how the new treatment compares to the standard approach: Is it just as safe or safer, and is it more effective? If the answers to these questions are yes, then an experimental treatment becomes the new standard of care.

“Sometimes people have this notion that participating in a clinical trial means you’re going to be experimented on like a guinea pig, but that’s not true,” Dr. Masood says. “People who participate in a phase 3 cancer clinical trial never receive anything less than the currently available standard of care for their particular disease. Clinical trials offer the possibility of receiving more than the standard, so in Angela’s case, a promising immunotherapy that was not yet approved by the Food & Drug Administration for the treatment of triple-negative breast cancer.”

The trial Silva joined was both double-blind and randomized, which means that she was assigned by chance to one of two groups; one received the standard treatment while the other received the standard treatment plus the immunotherapy.

In this type of study, neither the trial participants nor the investigators know who is assigned to which group until the trial is over. This study design allows investigators to accurately compare treatments and helps eliminate potential bias.

While Silva did not know whether she received the immunotherapy, what she did know was that by February 2020, after four months of being on the trial, her tumors had shrunk.

“The tumors in my right breast and my lymph nodes had gotten so small that I was able to have a lumpectomy — a much less invasive surgery — instead of a mastectomy,” she says.

A care team who rallies

Silva’s surgery was scheduled for mid-March 2020, but by then cancer wasn’t the only thing she had to worry about. The COVID-19 pandemic was gaining traction, and cases of the virus were popping up all over the world.

Governors of several U.S. states, including Washington, issued stay-at-home orders and halted non-urgent surgeries in an effort to curb the spread of COVID-19 and ensure health care workers had access to enough protective equipment. As a result, Silva’s lumpectomy was canceled.

“I was terrified,” she says. “At the time, I was off treatment — I had nothing to help me fight this cancer. But my care team at MultiCare Regional Cancer Center rallied for me and got me in quickly before the restriction went into effect. I was never so happy to get surgery in my life.”

After surgery, Silva received additional treatment for several months, including radiation. Her path to survivorship was not a smooth one. Like many people with cancer, she dealt with unpleasant treatment side effects and faced constant uncertainty. She credits her long-time friend Tracy, who she considers her honorary sister, as well as her providers for supporting her through these experiences.

“Dr. Masood is an exceptional oncologist and really helped me through this part of my life,” Silva says. “So many members of my care team advocated for me and helped me emerge as a survivor.”

It’s been three years since she received her cancer diagnosis, and in that time she’s had the opportunity to reflect on the importance of the clinical trial in her treatment.

“Part of what participating in that trial gave me is peace of mind,” Silva says. “Not only did I have an oncologist and a nurse navigator advocating for me, but a whole research team — this big network of people supporting me and making sure I had the information I needed to make decisions. Thanks to them, I have a second chance at life.”

And it’s not a second chance that she takes lightly. Today, she focuses on living a healthy lifestyle and puts her expertise to use as a small business owner and freelance consultant for mission-driven organizations and individuals.

However, one thing that hasn’t changed is Silva’s gratitude and passion for research.

“Often, I think when a person is diagnosed with cancer, their first thought is, who is the best in the world to cure it? Where can I find the latest treatments and trials?” she says. “They forget that maybe it’s all right here in their own backyard.”

MultiCare screens every patient with a cancer diagnosis for clinical trials and other studies that may be a good fit for their situation. To learn more about leading-edge research in cancer and other areas, visit the MultiCare Institute for Research and Innovation.