Brianne Dart’s cancer journey began in 2006. She was 21 years old when she was diagnosed with a superficial melanoma on her neck. Her physician performed a sentinel node evaluation and a wide excision of the area, and her margins came back clear. She didn’t worry about it and went on with her life. It wasn’t until 9 years later that she would learn she had stage IV melanoma.
She and her husband Dave met in college, got married and had 4 babies within 5 years. “When my youngest son was 3 months old, we were just excited for life. I told Dave, ‘let’s wait for our fifth baby. My body needs a break,’” she recalled at the AONN+ 9th Annual Navigation & Survivorship Conference. “Little did I know that melanoma was growing inside me.”
She had noticed that her breasts were getting lumpy on both sides, but she chalked it up to mastitis, an infection she had developed in the past. Her OB/GYN sent her for a mammogram, but her radiologist surmised that it couldn’t be cancer because of the rapid growth rate. He planned to send her home with antibiotics and a scheduled checkup a few weeks later, but when she complained about the intense abdominal pain she was also experiencing, he took note of her medical history and sent her for a CT scan immediately.
“My radiologist took a lot of time with me; actually, every doctor I came across in my process was a huge navigator for me,” she said. “I think the decision he made saved my life. If I hadn’t gone in for that CT scan and had waited 3 weeks to come back, I’m really not sure I would be alive right now.”
The CT scan revealed about 30 lesions throughout her entire body—in her pancreas, lungs, liver, heart, lymph nodes, breasts, and legs—the biggest ones ranging from 6 to 7 cm in size. “That was a big moment,” she remembers. “But I was still hoping it wasn’t cancer.”
Figuring Out Next Steps
Brianne’s OB/GYN referred her to an oncologist in Austin in June 2015. A biopsy confirmed her fears: she had stage IV melanoma.
“At this point, there weren’t really any great drugs approved for melanoma,” she said. “My oncologist told me my best option was to go to MD Anderson and try to get on a clinical trial. I told him ‘No, I have all these kids at home. I’ll just go to a local oncologist and have them hook me up to some chemo. I don’t care what I have to go through, but I’m not going all the way to MD Anderson.’”
Her husband talked her out of that idea. Within a week and a half of being diagnosed with advanced melanoma, she was sitting down with a specialist at MD Anderson and was scheduled to start a clinical trial the next day.
“She was explaining my treatment options, and it was a whirlwind. I really didn’t want to be a guinea pig; to me it sounded like there were no more options, so now we’re going to try this,” she said. “So much happened so quickly, but I’m glad it happened quickly because once you’re in the moment you roll with it all. You just keep going.”
She started combination treatment with ipilimumab and nivolumab, 2 immunotherapies approved for the treatment of melanoma, and says the first couple of months on treatment “wiped her out.” Even on 2 types of morphine and hydrocodone, she recalls her pain as excruciating.
“There’s just nothing like tumor pain,” she said. “And there’s really nothing they can do about it other than, hopefully, wait until the tumor shrinks.” In addition to her husband and the help of a nanny, she credits her strong family support system—her mother, father, and 6 siblings, all living nearby—for getting her through the toughest times. She also considers herself fortunate to have avoided any life-threatening side effects.
About 2 months into treatment she began to have more energy, and her pain had subsided significantly. “I was excited,” she said. “I was ready to go in for my first scan to see if the tumors had shrunk.”
She recalls her oncologist coming into the room with a big smile on her face. An MRI, a CT scan, and a PET scan showed no evidence of disease. “That blew our minds,” she said. “To this day I’m just amazed at how well these drugs work.”
After a year of remaining cancer free, her doctor told her she could stop taking nivolumab. “We had a little party and I rang the bell, but about a month later I fell into bed with excruciating pain in my lower abdomen,” she said.
After a trip to the emergency department she learned her melanoma was back. Because of how quickly her cancer was growing, her doctors made the choice to start her on BRAF inhibitors. “I’m BRAF-positive, which I’m thankful for. It makes the tumors accelerate more quickly, but there are more drug options,” she said. “There’s a very high chance that they will be effective in shrinking the tumors; the only downside is that your body usually becomes aware of these drugs, and after around 8 to 15 months the cancer can come back.”
They hoped that her next set of scans would show that her tumors had shrunk enough to be surgically removed, but her cancer was completely gone; there was nothing to remove. She stayed on BRAF inhibitors for a few months, then continued on treatment with nivolumab.
“And that’s where I am now. In January I was 2 years cancer free…again,” she said. “I’m not naive; there are aspects of fear that creep in, and I know this cancer can come back anytime. But I’m so excited about the future of these new drugs and the advancements they’re making. I’m just thrilled to be alive and with my kids.”