The second life of Leila, the first patient in the world with breast cancer who was able to access the liver transplant – Repubblica.it

"July 12 is my second birthday," says Leila B. full of enthusiasm recalling the day when, thanks to a liver transplant, she returned to live. The intervention was carried out in Rome at the San Camillo Forlanini hospital: the first case in the world of a liver transplant following liver metastases from a breast tumor. This intervention is, in fact, indicated exclusively for those who have a primary liver tumor or a form of liver cirrhosis, but Leila did not fall into either of these two categories. A unique case, therefore, his, because it had peculiar characteristics that allowed doctors to set up a pilot study to hoc. "They gave me a second life – says Leila – just when I had lost hope": her voice, which trembles a little with emotion, contains almost 20 years of suffering that had an unexpected turn.READ – First liver transplant after metastases for breast cancer cancer

Leila's story

"It all started in 2000 – he says – when, during a checkup, they found a breast lump. I was 32 years old and I did regular checks because two of my aunts had died of breast cancer ". His tumor was Her2 positive, aggresive type, but had been discovered at an early stage: "I had performed quadrantectomy surgery in Rome at the Fatebenefratelli Hospital. After surgery and histology, the surgeon and oncologist recommended mastectomy, but I decided not to do it. An instinctive choice, made a little out of fear and a little to convince me that the situation was not serious. So, after the quadrantectomy, I did both chemotherapy and radiotherapy, and then continued with hormone therapy for 5 years and with a drug targeted against my specific type of tumor ".

But in 2008 the first liver metastases appeared and since then the situation has become increasingly difficult. The chemo was effective and made them disappear, but after the cycles continued to recur in an increasingly aggressive manner, and after about two years the effects of the various treatments became evident: the liver was necrotized in several points. Faced with this situation, Leila had been offered a local treatment, hepatic radioembolization: a nuclear therapy that involves the use of Yttrio-90 microspheres to be injected into the femoral artery and that, once metastases are reached, prevent nourishment from reaching the cancer cells.READ – Fight, live, smile – The blog on metastatic breast cancer

The situation is getting worse

"It had worked, but again, after a few months of respite, the metastases had returned to other parts of the liver and I had to go back to chemo, radiometabolic therapy, two other thermal ablation and a radiofrequency. In the following 10 years, then up to 2018, the situation worsened: the metastases continued to recur until finally the liver, now almost all necrotized, was going to cirrhosis. In 2018, despite the last thermoablation, around the treated area, the tumor was still there and the doctors told me that the chemotherapy treatments could no longer be taken into consideration, because the liver – he says with a firm voice – could no longer bear them . At this point, I couldn't do anything anymore. "

The possibility of transplantation

Due to severe hepatic insufficiency, in 2019 Leila was transferred to the hepatology department of the San Camillo in Rome, taken over by the infectivologist Adriano Pellicelli and by the hepatologist Valerio Giannelli. Faced with this situation, the doctors of the hospital and of the Sapienza University of Rome discuss the possibility of liver transplantation. "We asked the Regional Transplant Center to be able to perform liver transplants," says Giuseppe Maria Ettorre, Director of the Inter-company Transplantation Department at the Inter-hospital Hospital Transplant Center of San Camillo-Forlanini – INMI Lazzaro Spallanzani of Rome. "The regional center has forwarded the request to the National Transplant Center which authorized the intervention with two indications. The first was that a pilot study was approved by the Lazio ethics committee and the second was that only organs from the same region were used. A pilot study was thus developed for which the ethics committee gave the green light and, at this point, the woman was included in the list to receive the transplant ".

A special case and for now only one

It is only thanks to the study designed ad hoc, therefore, that Leila was able to access the transplant because it presented particular conditions. "Stable and controlled cancer disease for many years, metastases present exclusively in the liver and liver failure due to chemotherapy and radiotherapy in the terminal phase", explains Ettorre: "The woman, followed for years by Dr. Enrico Cortesi, oncologist of the Polyclinic Umberto I and then in Latina by professor Roberto Cianni, interventional radiologist, for radiometabolic therapy – Ettorre continues – had presented only liver metastases 10 years after primary breast cancer and over time he had developed this severe liver failure, for which he had been transferred to the San Camillo ”.

"This is a very special case," says Massimo Cardillo, Director of the National Transplant Center. "Normally such a case is not included in the indications for liver transplantation and for this reason it has been evaluated with great attention by a multidisciplinary team with the opinion of the experts of the Transplantation Network. One had to be sure that the disease was present only in the liver and not in other places: the fact that for about 10 years the only localization of the metastases had been the liver was encouraging and, moreover, also some particular biochemical blood parameters indicated that the disease was confined only to the liver ".

Does this mean that even other patients with liver metastases following breast cancer will now have the possibility of transplantation? "For the moment absolutely not, also because it is rare that the metastases appear only in a specific organ", Cardillo specifies. "This is a special case that we must now carefully evaluate over time to eventually develop studies to extend this type of intervention to other patients as well."

The news of the availability of the liver

"I signed up for the transplant, but in the meantime – says Leila without hesitation – the situation got worse. The liver could not have worked more than a month: I was aware that it would be very difficult to find a compatible donor in such a short time. But then, after three weeks, the news of the organ's availability arrived ". Leila gives herself a silent pause, breathes deeply and then, almost in one breath, she recounts: "It was an enormous, indescribable emotion: I started to cry, a river of tears that flowed without interruption and that there was no way to stop. I do not deny that in the beginning, when the doctors told me that transplantation was necessary, I was very afraid: obviously it was not easy to live with the thought that, for me to have this possibility, something bad would have to happen. other human being. I worked a lot on myself to accept the idea that transplantation is not a selfish choice, but an act of love, as the doctors explained to me several times and, during the three weeks I was hospitalized before arrival of the liver, I realized that for me transplantation was the only possibility of life. Even immediately after the intervention – she says excited – I cried moved, thinking about the luck of being able to continue living ”.

The intervention lasted about ten hours; then two days of pharmacological coma followed, intensive care and, finally, an isolation phase. "I was followed by an exceptional team and I have a fantastic memory of every single person I met: doctors, nurses, nutritionists" – he repeats several times, underlining a deep admiration for their work – "After about two months I immediately started again at work and I returned to everyday life. I hope other women can have this chance in the future. "