Tailor-made treatment

Summer 2015

Receiving a diagnosis of breast cancer can be terrifying, but when you’ve also watched your mother wage the same battle – it can hit home on an even deeper level. That was certainly so for Margaret Greene who, at 68 years old, discovered a lump in her breast.

“It turned my whole world upside down,” she says of hearing her family doctor deliver the diagnosis of a very aggressive form of cancer present in both breasts. “I thought, how could this happen to me?”

The course of treatment for Margaret would be lengthy and complicated by other health conditions. As a diabetic, she could not undergo chemotherapy and, after a double mastectomy, lymph node surgery and radiation, the medication prescribed to her became a crucial part of her journey back to health. An inhibitor drug called tamoxifen, designed to prevent the resurgence of cancer, was added to the many medications prescribed to keep her recovery on track.

But Margaret’s body did not react well to the medication mix. She developed arthritis and spent her days feeling nauseated.
“I just couldn’t tolerate any of them,” she says of the drugs.

When it became clear that her wellbeing was suffering under the very treatment designed to save her life, she was referred to LHSC’s Dr. Richard Kim and the Personalized Medicine Clinic.

Personalized medicine is a new way of practicing medicine where a patient’s medication history, diet, environmental factors and their genetic makeup are all examined with the goal of tailoring the best medical treatments for each unique individual.

At the LHSC Personalized Medicine Clinic, Dr. Kim analyzed Margaret’s blood to learn how her body was metabolizing (using) the tamoxifen – a key measure of whether or not the drug was effective.

“What we found was that another medication that she was taking was having a significant interaction with the tamoxifen – dramatically lowering its efficiency. Because the drug wasn’t working efficiently, this meant that she was also potentially exposed to the risk of breast cancer recurrence,” says Dr. Kim.

“Learning about how the body is using tamoxifen is very important. As patients typically need to take it for five to 10 years, you want to know you’re getting the maximum benefit. Our approach through the Personalized Medical Clinic enables very specific treatment adjustments that do just that for each individual we see.”

After discovering the interaction, and with her physician’s help, Margaret was weaned off of the drug that was reducing the tamoxifen’s effectiveness and the level of the active tamoxifen in her system increased four-fold, so that its efficacy reached a level that fell within the normal range.

“I had never heard of personalized medicine before,” says Margaret. “But Dr. Kim was very interesting to talk to. He gave me a lot of positive thoughts and the staff that he has working there are just wonderful.”

Margaret’s plan is so detailed, she even knows the right time of day to take the medication.

“I’m able to tolerate the tamoxifen,” says Margaret, adding that she no longer has nausea. Now, seven years after her initial breast cancer diagnosis, Margaret is, and remains, cancer free. She vividly recalls receiving the good news. “It was just wonderful. I was delighted,” she says with smile. “The diagnosis and drug side-effects had turned my world upside down, but hearing that I was cancer-free turned it back up again.”

For others who may find themselves battling illness, Margaret offers words of encouragement.

“Cherish every moment in every stage of your journey. Positive thoughts are a must. Each day will feel brighter if you accept what’s going on.”

Although she is now cancer-free, Margaret must continue taking tamoxifen to ensure that she stays that way.

Thankfully, her tailor-made plan ensures that she continues to receive the right dose, of the right medication, at the right time.

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Patient Margaret Greene has benefitted from personalized medicine, at LHSC's Personalized Medicine Clinic.
At the Personalized Medicine Clinic, Dr. Richard Kim helps tailor medical treatment to each individual patient.