LatestJoining TROPION-Breast06
Miriam Gonzálezhelpmiriam.com

The case in data

Miriam’s clinical course at a glance, and where every number comes from.

Updated Sep 28, 2026 · Download the data

A summary of her reports, as decision support. Not a diagnosis or medical advice.

Breast cancer with neuroendocrine differentiation (BC-NED), HR+/HER2− (IHC 0), biopsy of Jan 2024 verified

Pathology and molecular profile on The science page →

Today

  • ECOG0Sep 9, 2026 verified
  • Systemic lines31L · 2L · 3L
  • Never receivedchemotherapy · ADC · immunotherapy · radioligands / PRRT · cell therapy · elacestrant verified
  • Central nervous systemnot studied (not a negative) verified
  • Bone: innumerable blastic/mixed/lytic metastases throughout the skeleton verified
  • Liver: multiple metastases since Jul 2026, increasing verified
  • Right breast: upper outer quadrant primary 15 mm (BI-RADS 6), slightly increasing verified
  • No RECIST-significant lung or nodal metastases verified

Treatment

No systemic line

Goserelin ongoing. Next: Datopotamab deruxtecan, planned for Oct 2026.

In TROPION-Breast06 (VHIO): tests before the first dose. verified

last 90 days · tall = on treatment

since Sep 9, 2026 (end of 3L) verified

CA 15-3

512.8UI/mL

above range

14.7 times the upper limit

before: 509.5 · Sep 8, 2026

Sep 16, 2026

Hemoglobin

10.6g/dL

below range

before: 7.8 · Sep 8, 2026

In between, a transfusion in the emergency room on Sep 9. inferred

Sep 16, 2026

Liver (AST)

1.7×upper limit

above range

AST 59 · ALT 38 U/L

before: 2.9× (100 U/L) · Sep 8, 2026

Sep 16, 2026

What changed between the last two lab reports

Sep 8, 2026 → Sep 16, 2026

Every value: extracted from report

In between: end of 3L on Sep 9 verified

Sep 8 Sep 16 · out of range · flagged on report

Multiples of each report’s upper limit; in gray, its normal range.

  9. In between, a transfusion in the emergency room on Sep 9. inferred

  11. Up to 30-40% change can come from the lab and biology alone (a 95% statistical limit, not a clinical one; it can be larger if another underlying disease raises the marker; SEQC/SEOM 2021 consensus). This change: +28.6%. This range compares only this test against the last one; it doesn’t assess the disease overall. verified

  26. Up to 19-34% change can come from the lab and biology alone (a 95% statistical limit, not a clinical one; it can be larger if another underlying disease raises the marker; SEQC/SEOM 2021 consensus). This change: +0.6%. This range compares only this test against the last one; it doesn’t assess the disease overall. verified

Only tests with a value on both dates, sorted by relative change, largest first. The percentage comes from the two values; the multiple of the limit, from each value and its own report’s limit.

Sparklines: up to the last 12 values. In gray, each report’s normal range; hatched, the lab’s usual one when the report prints none. ▲▼ out of range; ◆ flagged on report.

Organ and bone marrow function · Sep 16, 2026 extracted from report

Tumor burden

RECIST sum (radiologist)0 mm20406080+20 %74 mmTumor volume in the liver (model)11.9 mlSep 8, 2026 · 20 lesions

+8.8 % RECIST sum (68 → 74 mm). RECIST calls progression from +20%.

×4.3 model volume (2.8 → 11.9 ml) and 9 to 20 lesions.

The two measurements disagree and have not been reconciled yet: the radiologist reported no new lesions; the model segments 20, several under 10 mm, without radiological validation.

RECIST: radiologist’s report verified · Volume: segmentation model on the same CT scans, not validated by radiology.

Latest PET · Sep 8, 2026 verified

18F-FDG PET-CT (report signed on 9 Sep): “Hepatic and bone progression, due to the appearance of new active lesions” (spine, right scapula, ribs, pelvis, femurs). Liver s.IVb SUVmax 4.5 and s.VIII 3.6. The same-day CT reports “stability of the M1 bone involvement”

3 earlier PET scans
  • Jul 10, 2026 · 18F-FDG PET-CT (BG-75202 trial screening): first liver lesions; liver s.IVb SUVmax 2.6 and s.II 2.2 according to the report verified
  • May 26, 2026 · 68Ga-DOTATOC PET: SSTR overexpression in multiple blastic bone metastases (SUVmax up to 13.27 in D11, 12.1 in L5), but heterogeneous: several lesions without uptake and the left pedicle of L1 FDG+ / Ga−. Focal uptake in the tail of the right breast, SUVmax 2.64, “to be assessed with a targeted study” (the report does not call it the primary). The liver had no lesions yet: its SSTR status is unknown. No Krenning score in the report verified
  • Mar 24, 2026 · 18F-FDG PET-CT: suggestive of bone progression. Persistent hypermetabolism in D11 (SUVmax 7.61, previously 10.19), L5, right sacral ala, right supra-acetabular iliac, right femur (SUVmax 9.43, previously 6), left pedicle of L1 (6.84, previously 4.67); new foci in D1 and left supra-acetabular iliac verified
Lesion by lesion
LesionDateDiam. mmVol. mlSUVmax
L1 · seg VII · no vista en el TC previo2026-09-0816.71.992.16
L2 · seg II · diana RECIST (radiólogo 18→20 mm) · crece (+47,5 % diámetro, +309 % volumen vs 13-jul según el modelo) · SUV 8-sep por debajo de la media hepática pese a crecer: pregunta abierta para radiología2026-07-10——2.39
2026-09-08181.81.29
L3 · seg IV (IVb) · diana RECIST (radiólogo 15→19 mm) · crece (+24,3 % diámetro, +60,5 % volumen vs 13-jul) · la más activa en PET (informe 4,5)2026-07-10——2.58
2026-09-0813.81.224.22
L4 · seg V · crece (+91,5 % diámetro, +245 % volumen vs 13-jul)2026-07-10——1.62
2026-09-0813.61.071.17
L5 · seg VII · crece (+132,7 % diámetro, +791 % volumen vs 13-jul)2026-07-10——1.69
2026-09-0812.80.981.99
L6 · seg VIII · crece (+43,4 % diámetro, +171 % volumen vs 13-jul)2026-07-10——1.79
2026-09-0811.90.841.89
L7 · seg VI · crece (+62,9 % diámetro, +250 % volumen vs 13-jul)2026-07-10——1.37
2026-09-0811.40.72.1
L8 · seg VIII · no vista en el TC previo2026-09-0811.40.642.12
L9 · seg VI · no vista en el TC previo2026-09-0810.60.571.93
L10 · seg V · estable (+6,7 % diámetro, −16,1 % volumen vs 13-jul)2026-07-10——2.05
2026-09-0811.10.472.38
L11 · seg III · no vista en el TC previo · SUV sobre fondo2026-09-0810.40.473.07
L12 · seg III · no vista en el TC previo · <10 mm2026-09-088.40.311.66
L13 · seg VI · no vista en el TC previo · <10 mm2026-09-087.90.242.09
L14 · seg VI · no vista en el TC previo · <10 mm2026-09-086.60.162.01
L15 · seg IV · no vista en el TC previo · <10 mm · borde contaminado2026-09-086.30.152.43
L16 · seg VI · no vista en el TC previo · <10 mm2026-09-085.70.111.91
L17 · seg IV · no vista en el TC previo · <10 mm · borde contaminado2026-09-085.30.12.03
L18 · seg VII · no vista en el TC previo · <10 mm · PET no evaluable2026-09-084.10.05—
L19 · seg VIII · no vista en el TC previo · <10 mm · PET no evaluable2026-09-085.30.05—
L20 · seg V · no vista en el TC previo · <10 mm · PET no evaluable2026-09-082.20.02—
Focos PET 8-sep sin lesión en el TC a <10 mm: seg VII (SUVmax 3,77), seg VIII (3,6; el informe lo destaca), seg IV (3,41). Dos lesiones de julio en seg I (4,4 y 2,2 mm) no reencontradas2026-09-08——3.77

In 3D, with the radiologist’s measurements: breast, liver and bone

Tissue and samples

All available material is in paraffin. There is no fresh or frozen tissue and no PBMC. verified

Bone, iliac crest

biopsy 8 Jul 2026, Zurich. 6 cores of 4-11 mm in 4 blocks A-D; per block 1 good, 1 poor and 2 unusable. Paraffin, decalcified (method not documented). No fresh or frozen

Where Dana-Farber (shipped 27 Aug 2026, received 2-3 September) · Status Scarce: the FoundationOne CDx consumed part of block A. Receipt confirmed to the laboratory according to the patient (24 Sep)

2026-07-08 verified

Liver, segment IVa

core needle biopsy 18 Aug 2026, ultrasound-guided, 2 cores 16G × 23 mm, 2.2 cm lesion. Only liver biopsy. Paraffin

Where Sections at Dana-Farber (shipped 21 Sep, received 23 Sep 2026); original block at VHIO / Vall d'Hebron pathology · Status Limited: the requested allocation (2×25 µm for scRNA-seq + 1-2×10 µm for WES) “would practically exhaust” the block; the combination cut and the remainder are not documented in writing. Pathology report pending.

2026-08-18 verified

Breast, primary

core needle biopsy 16 Jan 2024. Paraffin. Tumor purity 75 %. Reviewed again in 2026

Where Vall d'Hebron pathology (after the central review) · Status The most abundant. Block location: deduced, not confirmed in writing

2024-01-16 inferred

6 more samples

Slides of the breast primary

H&E, HER2, p63. 3 slide holders

Where Dana-Farber (shipped 21 Sep, received 23 Sep 2026) · Status Stain and number per slide according to the label; scRNA-seq from slides requires unstained sections (according to the manufacturer)

2024-01 verified

Bone, right iliac

re-biopsy 30 Apr 2026, Morales Meseguer. bone trabeculae and musculoskeletal fibers, no neoplasia. Paraffin

Where Dana-Farber (shipped 21 Sep, received 23 Sep 2026) · Status Sent deliberately in case the tissue is useful, although it probably contains no tumor

2026-04-30 verified

Breast

biopsy 5 Jun 2026 for trial screening. minimal analyzable sample (0.3 mm), insufficient

Where Vall d'Hebron pathology · Status Insufficient for diagnosis; not liver material (correction of 13 Sep)

2026-06-05 verified

Plasma

4 tubes (May 2026)

Where Dana-Farber · Status According to an internal note of 5 Sep 2026, not reopened

2026-05 unverified

Germline DNA in solution, ~500 ng

“can be with less”. , as matched normal for the WES

Where Pending shipment to Dana-Farber · Status Recorded only in chat (21 Sep); written confirmation that tumor and germline are sequenced as a pair: requested on 24 Sep

2026-09 per Miriam

Fresh / frozen tissue / PBMC / buffy coat

Where None at any center · Status Does not exist. The only route would be a new biopsy with extra fresh or frozen non-decalcified cores, and blood before the first cycle (germline DNA, HLA, PBMC)

2026-09 verified

What we’re looking for

  • Laboratories or groups able to predict and validate neoantigens from paraffin (tumor/germline WES + 10x Flex scRNA-seq already under way) and to manufacture personalized therapy (neoantigen vaccine, TIL, TCR-T, CAR-T) for an HR+/HER2 0 breast carcinoma with neuroendocrine differentiation and liver metastases inferred
  • High-resolution HLA class I/II typing and tumor MHC-I/B2M status: comes from blood, uses no tissue, and opens or closes TCR-T and vaccine inferred
  • Target IHC on the liver tissue (TROP2, Nectin-4, DLL3, SSTR2, B7-H3, CEA) and the histology of the progressing liver lesion: this is the data point that opens or closes ADC, radioligand and cell therapy options verified
2 more
  • Trials or access programs (any country) for AFTER TROPION-Breast06 that accept: no prior chemotherapy, HR+/HER2 IHC 0, a neuroendocrine component, liver metastases, Hb around 9-10 g/dL and a prior anti-TROP2 (the Dato-DXd of TROPION-Breast06). With checked figures: TB06 does not close NEXTGEN-TIL (NCT05141474) or TROPIKANA (NCT06066424); it does close other topoisomerase I ADCs verified
  • Radiology: expert read of the liver (correspondence of the 3 PET foci without a CT lesion; s.II target growing with low SUV; advisability of liver MRI with hepatocyte-specific contrast or multiphase CT to characterize the lesions <10 mm) verified
Write to us →

Clinical course

Oct2026AprJulOct2L · Fulvestrant 500 mg im every 28 d + abemaciclib 100 mg every 12 h (dose reduced from cycle 1; prescribed 150 mg) + LHRH agonist → bone progression (FDG-PET of 24 Mar 2026)2LRT-2026 · SBRT to D11, 5 fractions → completed3L · Fulvestrant + BG-75202 (oral KAT6A/B inhibitor, phase 1a/1b trial NCT07222267, cohort 1B, Vall d'Hebron) → clinical hepatic progression at 8 weeks (RECIST SD +8.8 %, but hepatic growth with worsening liver function and CA15.3 ×3.5)3L4L · Datopotamab deruxtecan (Dato-DXd, anti-TROP2, topoisomerase I payload) 6 mg/kg every 3 weeks; single-arm phase IIIb trial TROPION-Breast06 (NCT07205822), Vall d'Hebron
Tap a symbol or use the arrows to see what happened.

diagnosisprogressionbiopsyhospitalizationradiotherapy

Labs

Same axis as the timeline above. ▲▼ out of range; ◆ flagged on the report without leaving the range; 1× is the upper limit of normal. Tap a chart to see that date on all of them.

CA 15-3

512.8 UI/mL · 14.7× Sep 16, 2026

above
20260.25×0.5×1×2×5×10×
All 10 values · 10 out of range
DateValueReference range
2026-09-16512.8 ▲0–35
2026-09-08509.5 ▲0–35
2026-08-19215.4 ▲0–35
2026-04-2259.9 ▲0–23.5
2026-03-2358.1 ▲0–23.5
2026-02-2651.9 ▲0–23.5
2026-02-1851.9 ▲0–23.5
2026-01-0848.1 ▲0–23.5
2025-12-1144.4 ▲0–23.5
2025-11-1346.8 ▲0–23.5

CEA

0.9 ng/mL · 0.3× Sep 16, 2026

within
20260.25×0.5×1×2×
All 9 values
DateValueReference range
2026-09-160.90–3.5
2026-09-080.70–3.5
2026-04-2220–5
2026-03-232.20–5
2026-02-261.80–5
2026-02-1820–5
2026-01-081.70–5
2025-12-111.80–5
2025-11-131.80–5

LDH

431 U/L · 1.8× Sep 16, 2026

above
20260.25×0.5×1×2×
All 10 values · 6 out of range
DateValueReference range
2026-09-16431 ▲120–246
2026-09-08483 ▲120–246
2026-08-26374 ▲120–246
2026-08-19512 ▲120–246
2026-04-22254 ▲120–246
2026-03-23241120–246
2026-02-18259 ▲120–246
2026-01-08201120–246
2025-12-11226120–246
2025-11-13230120–246

Measured once or twice

TestDateValueReport range
CA 125Jan 15, 202430.7 UI/mL ▲< 30.2
Jul 12, 20247.7 UI/mL< 35
CA 19-9Jan 15, 202426 UI/mL< 37
Jul 12, 202442.8 UI/mL ▲< 34
CA 27.29Jul 12, 202464.9 UI/mL ▲< 38.6
Beta-2 microglobulinJan 15, 20241.4 mg/L1–2.4
Jul 12, 20241.46 mg/L0.8–2.4
Chromogranin AJul 12, 202457.67 µg/L< 100
Neuron-specific enolase (NSE)Jul 12, 202413.5 ng/mL< 16.3

The MD Anderson report notes that chromogranin A is not a specific tumor marker: other conditions and some drugs also raise it.

extracted from report How they are read and dated: under “Sources and method”.

The case, seen another way

The same data as above, drawn to be seen at a glance. Click or tap a dot or a day to read it; from there you can jump to that date.

1,730 lab values

Each dot is one. The 731 violet ones fell outside the range.

Tap a dot to read it.

in rangeout of rangeprogressiontreatment line

Every day since diagnosis

987 days

871 on a treatment line · 86 with no line running · 30 with an approximate date · 65 lab reports

Pick a day to read it.

1L2L3Lno lineapproximate datelab report: stroke up, values above range; down, below range. Longer means more valueslab report, all in range■ CT with RECISTprogression● radiotherapy next to the month: progression or radiotherapy known only by month

Venous port: the catheter measures the same length on all three CT scans

The port stopped giving blood return. Catheter length, port to tip, on three CT scans:

0 mm50 mm100 mm150 mmMar 24, 2026150.8 mmJul 10, 2026152.2 mmSep 8, 2026151.7 mm

port tip measurement margin

Semi-automatic measurement on her CT scans, not validated by radiology. verified

The full port story →

The course, in motion

A playhead runs from diagnosis to today and the charts in “Clinical course” draw as it passes.

You’ll find the full diagnosis, receptors, treatment history and molecular profile on The science page.

Sources and method

We build this page from a profile we review by hand against Miriam’s reports, from lab values read off her lab reports and from this site’s timeline. If something has no source, we don’t publish it. Labels: verified (checked against the original report), extracted from report (read automatically), inferred, per Miriam (no document behind it) or unverified.

Lab reports, read by the lab parser and dated by the day the sample was drawn. The three from August and September 2026 are extracted from the lab's original PDF. From the MD Anderson panel (July 2024), only the uncommon markers and the hormones; its CA 15-3 and CEA, run with a different assay, are kept out of the Murcia series. Blood samples only, only values read with high or medium confidence, nothing calculated by us. The < sign marks a value below the limit the lab can measure.

  • Consolidated clinical status of the case (§1-§3 rewritten on 11 Sep 2026 from the original reports; addenda up to 24 Sep)
  • Clinical update 15 Aug to 11 Sep 2026: IHC tables by sample, RECIST, laboratory tests and de-identified profile
  • Table of genetic alterations by sample, checked against the six original molecular reports (2024-2026)
  • Codes of the paraffin-embedded material sent to Dana-Farber (shipped 21 Sep, received 23 Sep 2026)
  • Summary of the Zurich bone block (Jul 2026): pathology and FoundationOne CDx
  • Hepatic tumor burden by automated segmentation, CT 13 Jul vs 8 Sep 2026 (trend, no radiological validation)
  • Per-lesion liver sheet: density, July-September course and PET (model, checked against the reports on 21 Sep 2026)
  • Output of the liver segmentation model (CT 8 Sep 2026 vs 13 Jul 2026; PET 10 Jul and 8 Sep). Measurements from a model, no radiological validation
  • Report of the first medical oncology visit (25 Jan 2024)
  • Oncology visit report, start of second line (4 Feb 2025)
  • Report of the 18F-FDG PET-CT of 24 Mar 2026
  • TROPION-Breast06 (NCT07205822): criteria, sequencing and access (13 Sep 2026)
  • TROPION-Breast06 entry plan: 16 Sep screening and schedule up to the first dose (19 Sep 2026)
  • Public chronology on the website (timeline)
  • Reservoir catheter path rebuilt on her 2026 CT scans (semi-automatic measurement, not validated by radiology)
  • Email from the TROPION-Breast06 study coordination (VHIO), 21 Sep 2026