Why Liquid Biopsy

My name is Miriam. I'm 37 years old. I’m a mother a large family with beautiful children, from age 17 to my youngest, who is three. My journey began two years ago, at the end of 2023. It was summertime when I started noticing some abnormalities, a rash under my arm and a lump under my right arm. I didn’t fully understand that this all can be related. It took me a few visits, appointments, and testing to face the reality more and more —that this was something called cancer, which I never imagined I would face in my life. Especially so early. My husband, S, who then had just earned his degree in clinical social work, was incredibly supportive. We waited together for clarity on what was happening before sharing it with our family. After two weeks, a biopsy confirmed triple-negative breast cancer. It was new and frightening for us. My understanding was that it is very aggressive and lacks the three main treatment targets that other breast cancers can have. It was large — about 6.9 cm in the lymph nodes. That night is something I will remember forever. I remember my husband and me in our room, calling in one by one our kids, depending on their age. We tried to explain the situation in an encouraging and natural way. We reassured them that therapies today are effective, and with God’s help, after a six-month regimen, we would be okay. But it will be challenging, and we will face it together. In early December 2023, we started treatment Keynote 522, AC, TC Pembro — completely new for us, though perhaps routine for some of you. It wasn’t without challenges: rashes, side effects, and even one hospitalization due to a rash suspected to be Sweet syndrome. Through all of this, imaging reassured us that there was some response. In May of 2024, we went into surgery, hoping for a complete or near-complete response. The pathology revealed a harsh reality: 41 out of 42 lymph nodes removed were positive. Thanks to God, the margins were clean. Three weeks later, I began radiation: a full regimen, five weeks of treatment. The good news came in the end of July 2024: the first liquid biopsy test showed no ctDNA detection — very encouraging for us. We also did a PET scan which showed no active disease. I started oral treatment with a PARP Inhibitor, which I was on for one full year. We continued testing every three months through liquid biopsy for that year, and each time it was reassuring — zero ctDNA detection. I stopped taking Olaparib after the regular 12 months. My last dose was on Friday, August 29 of this year [2025]. Our next liquid biopsy test was on September 2, just four days later. We didn’t expect any difference from the previous year, but it showed 0.089 detection rate — a tiny detection. We hoped it was a mistake. We though, did Imaging — brain MRI and CT — which showed no metastatic disease, but the doctor worried that it might be too early to show on scans. So, four weeks later, we repeated the liquid biopsy test, which by then showed a detection rate of 0.827 — still low, but a rapid increase of 10-fold from the previous 0.089. We were scared, and we knew that we needed imaging right away. The following Sunday, a PET scan confirmed three bone lesions: two in the pelvis, one in the right shoulder. Um, it was very difficult to swallow. I didn’t have, even at this time of the PET scan, any pain, no back pain, or anything. According to the rate, how quickly and aggressively it progressed — within four weeks, double digits: from 0.089 to 0.827. Without this detection, considering the rapid progression of inflammatory breast cancer and its aggressive nature, I would have gone back to the doctor in a couple of months with pain all over. I’m petrified to think how the PET scan might have looked then. Thank God, with the science of liquid biopsies, we were able to detect it very early and gain that crucial time to explore various treatment options. We gained some time to see what works and what doesn't, and we gained time to consider some trials that could be the right fit. This news came on Oct 13, the day before our holiday, Succos. We were already thinking of celebrating the end of this journey with our family and children. But seeing these results, I knew it was not yet over. Even so, we tried to enjoy that day with our family, celebrating small moments before returning to the hospital. We met with the doctor the next day to plan the next steps. I immediately restarted the PARP inhibitor, but a stronger version. We are following closely with scans and liquid biopsies, which are giving us direction on how to proceed in my personal journey. I am very thankful to my husband, S, and my whole family for the strong support, which has given me so much hope. This journey has been frightening, overwhelming, and exhausting. But it has also shown me the strength of family, the importance of support, and the power of modern medicine. I must take a moment to express my deepest gratitude to my doctor, along with his team. He is much more than a doctor, he takes it personally to find new and better options to help us and others in times when it's so needed. In addition, I want to recognize the researchers, laboratory scientists, and teams behind technologies such as ctDNA testing. Their work is not always visible at the bedside, but it directly impacts clinical decisions and ultimately saves lives. The ability to detect recurrence at such an early phase — long before symptoms appear — has provided critical time and direction in my care plan. This precision is the result of years of research, development, and innovation. Together, these combined efforts — clinical, scientific, and supportive — create the framework that gives patients like me the best possible chance for timely intervention and continued treatment. Thank you for your dedication, your expertise, and your commitment to advancing the field so that patients can benefit from the most accurate and impactful tools available today. All this in one word “LIFESAVING!!” I share this story with you today not only to highlight the personal journey but to illustrate how advanced tools like ctDNA and precision medicine can make a vast difference in high-risk breast cancer, giving patients and doctors critical insights, enabling early intervention and ......hope.