Miriam’s clinical course at a glance, and where every number comes from.
Updated
Download the dataA summary of her reports, as decision support. Not a diagnosis or medical advice. Every number is checked against its original report; only what isn’t gets a mark: inferred, per Miriam or unverified.
Breast cancer with neuroendocrine differentiation (BC-NED); primary HR+/HER2 0; liver metastasis (2026) ER 0%, PR 5%, HER2 0, biopsy of Jan 2024
Pathology and molecular profile on The science page →Treatment
4L
Datopotamab deruxtecan
last 90 days · tall = on treatment
since Oct 7, 2026
CA 15-3
569.2UI/mL
above range
16.3 times the upper limit
before: 663.3 · Oct 6, 2026
Oct 27, 2026
Hemoglobin
10.4g/dL
below range
before: 10.8 · Oct 6, 2026
Oct 27, 2026
Liver (AST)
2.6×upper limit
above range
AST 87 · ALT 88 U/L
before: 2.6× (88 U/L) · Oct 6, 2026
Oct 27, 2026
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.
All available material is in paraffin. There is no fresh or frozen tissue and no PBMC.
Bone, right ilium
biopsy 8 Jul 2026, Zurich; the report says “rechtes Os Ileum”. 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
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 Block at Dana-Farber (shipped 21 Sep, received 23 Sep 2026, with its report), per the patient's email to the lab of 24 Sep · 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 signed on 21 Sep 2026: ER 0 %, PR 5 %, HER2 0, chromogranin A and synaptophysin positive; no Ki-67.
2026-08-18
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
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
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
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
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
+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 · Volume: segmentation model on the same CT scans, not validated by radiology.
Latest PET · Oct 5, 2026
18F-FDG PET-CT (TROPION-Breast06 screening, another centre): “signs of bone and hepatic metastatic spread. Subcentimetre, mildly avid nodes in both axillae. Pulmonary consolidations to be monitored.” Liver s.IV SUVmax 11.9 and s.II 6.2; bone up to 16 (sternum and L2). Different scanner and dose: its figures are not compared with those of 8 Sep, and the report does not compare with previous studies
| Lesion | Date | Diam. mm | Vol. ml | SUVmax |
|---|---|---|---|---|
| L1 · seg VII · no vista en el TC previo | 2026-09-08 | 16.7 | 1.99 | 2.16 |
| 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 radiología | 2026-07-10 | — | — | 2.39 |
| 2026-09-08 | 18 | 1.8 | 1.29 | |
| 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 |
| 2026-09-08 | 13.8 | 1.22 | 4.22 | |
| L4 · seg V · crece (+91,5 % diámetro, +245 % volumen vs 13-jul) | 2026-07-10 | — | — | 1.62 |
| 2026-09-08 | 13.6 | 1.07 | 1.17 | |
| L5 · seg VII · crece (+132,7 % diámetro, +791 % volumen vs 13-jul) | 2026-07-10 | — | — | 1.69 |
| 2026-09-08 | 12.8 | 0.98 | 1.99 | |
| L6 · seg VIII · crece (+43,4 % diámetro, +171 % volumen vs 13-jul) | 2026-07-10 | — | — | 1.79 |
| 2026-09-08 | 11.9 | 0.84 | 1.89 | |
| L7 · seg VI · crece (+62,9 % diámetro, +250 % volumen vs 13-jul) | 2026-07-10 | — | — | 1.37 |
| 2026-09-08 | 11.4 | 0.7 | 2.1 | |
| L8 · seg VIII · no vista en el TC previo | 2026-09-08 | 11.4 | 0.64 | 2.12 |
| L9 · seg VI · no vista en el TC previo | 2026-09-08 | 10.6 | 0.57 | 1.93 |
| L10 · seg V · estable (+6,7 % diámetro, −16,1 % volumen vs 13-jul) | 2026-07-10 | — | — | 2.05 |
| 2026-09-08 | 11.1 | 0.47 | 2.38 | |
| L11 · seg III · no vista en el TC previo · SUV sobre fondo | 2026-09-08 | 10.4 | 0.47 | 3.07 |
| L12 · seg III · no vista en el TC previo · <10 mm | 2026-09-08 | 8.4 | 0.31 | 1.66 |
| L13 · seg VI · no vista en el TC previo · <10 mm | 2026-09-08 | 7.9 | 0.24 | 2.09 |
| L14 · seg VI · no vista en el TC previo · <10 mm | 2026-09-08 | 6.6 | 0.16 | 2.01 |
| L15 · seg IV · no vista en el TC previo · <10 mm · borde contaminado | 2026-09-08 | 6.3 | 0.15 | 2.43 |
| L16 · seg VI · no vista en el TC previo · <10 mm | 2026-09-08 | 5.7 | 0.11 | 1.91 |
| L17 · seg IV · no vista en el TC previo · <10 mm · borde contaminado | 2026-09-08 | 5.3 | 0.1 | 2.03 |
| L18 · seg VII · no vista en el TC previo · <10 mm · PET no evaluable | 2026-09-08 | 4.1 | 0.05 | — |
| L19 · seg VIII · no vista en el TC previo · <10 mm · PET no evaluable | 2026-09-08 | 5.3 | 0.05 | — |
| L20 · seg V · no vista en el TC previo · <10 mm · PET no evaluable | 2026-09-08 | 2.2 | 0.02 | — |
| 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 reencontradas | 2026-09-08 | — | — | 3.77 |
In 3D, with the radiologist’s measurements: breast, liver and bone
diagnosisprogressionbiopsyhospitalizationradiotherapy
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.
569.2 UI/mL · 16.3× Oct 27, 2026
above| Date | Value | Reference range |
|---|---|---|
| 2026-10-27 | 569.2 ▲ | 0–35 |
| 2026-10-06 | 663.3 ▲ | 0–35 |
| 2026-09-16 | 512.8 ▲ | 0–35 |
| 2026-09-08 | 509.5 ▲ | 0–35 |
| 2026-08-19 | 215.4 ▲ | 0–35 |
| 2026-08-12 | 215.4 ▲ | 0–35 |
| 2026-07-14 | 145.2 ▲ | 0–35 |
| 2026-04-22 | 59.9 ▲ | 0–23.5 |
| 2026-03-23 | 58.1 ▲ | 0–23.5 |
| 2026-02-26 | 51.9 ▲ | 0–23.5 |
| 2026-02-18 | 51.9 ▲ | 0–23.5 |
| 2026-01-08 | 48.1 ▲ | 0–23.5 |
| 2025-12-11 | 44.4 ▲ | 0–23.5 |
| 2025-11-13 | 46.8 ▲ | 0–23.5 |
1.1 ng/mL · 0.3× Oct 27, 2026
within| Date | Value | Reference range |
|---|---|---|
| 2026-10-27 | 1.1 | 0–3.5 |
| 2026-10-06 | 0.7 | 0–3.5 |
| 2026-09-16 | 0.9 | 0–3.5 |
| 2026-09-08 | 0.7 | 0–3.5 |
| 2026-08-12 | <0.5 | 0–3.5 |
| 2026-07-14 | 0.7 | 0–3.5 |
| 2026-04-22 | 2 | 0–5 |
| 2026-03-23 | 2.2 | 0–5 |
| 2026-02-26 | 1.8 | 0–5 |
| 2026-02-18 | 2 | 0–5 |
| 2026-01-08 | 1.7 | 0–5 |
| 2025-12-11 | 1.8 | 0–5 |
| 2025-11-13 | 1.8 | 0–5 |
311 U/L · 1.3× Oct 27, 2026
above| Date | Value | Reference range |
|---|---|---|
| 2026-10-27 | 311 ▲ | 120–246 |
| 2026-10-06 | 468 ▲ | 120–246 |
| 2026-09-16 | 431 ▲ | 120–246 |
| 2026-09-08 | 483 ▲ | 120–246 |
| 2026-08-26 | 374 ▲ | 120–246 |
| 2026-08-19 | 512 ▲ | 120–246 |
| 2026-08-12 | 302 ▲ | 120–246 |
| 2026-07-29 | 436 ▲ | 120–246 |
| 2026-07-22 | 326 ▲ | 120–246 |
| 2026-07-14 | 407 ▲ | 120–246 |
| 2026-04-22 | 254 ▲ | 120–246 |
| 2026-03-23 | 241 | 120–246 |
| 2026-02-18 | 259 ▲ | 120–246 |
| 2026-01-08 | 201 | 120–246 |
| 2025-12-11 | 226 | 120–246 |
| 2025-11-13 | 230 | 120–246 |
Measured once or twice
| Test | Date | Value | Report range |
|---|---|---|---|
| CA 125 | Jan 15, 2024 | 30.7 UI/mL ▲ | < 30.2 |
| Jul 12, 2024 | 7.7 UI/mL | < 35 | |
| CA 19-9 | Jan 15, 2024 | 26 UI/mL | < 37 |
| Jul 12, 2024 | 42.8 UI/mL ▲ | < 34 | |
| CA 27.29 | Jul 12, 2024 | 64.9 UI/mL ▲ | < 38.6 |
| Beta-2 microglobulin | Jan 15, 2024 | 1.4 mg/L | 1–2.4 |
| Jul 12, 2024 | 1.46 mg/L | 0.8–2.4 | |
| Chromogranin A | Jul 12, 2024 | 57.67 µg/L | < 100 |
| Neuron-specific enolase (NSE) | Jul 12, 2024 | 13.5 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”.
Each treatment line has held the disease for a while before the tumour escaped. The pattern is compatible with targeting only the hormonal axis and leaving out the neuroendocrine component; the 2026 liver metastasis, ER 0% with positive neuroendocrine markers, fits that reading but does not prove it.
Diagnosis and palliative radiotherapy (January 2024)Completed
Diagnosed in January 2024 after presenting to the ER with low-back pain: de novo stage IV, with multiple bone metastases and spinal cord compression at L3. Premenopausal. Radiotherapy to L3 (30 Gy in 10 fractions, completed 29 January 2024) with progressive improvement. Palliative systemic treatment from February 2024.
Letrozole + Ribociclib + Zoladex (goserelin) + zoledronic acid (from February 2024)Completed
Ribociclib stopped after 15 days (within cycle 1) for neutropenic necrotising pneumonia, with a two-month admission, ten days in ICU. Goserelin + letrozole continued alone for 12 months.
Fulvestrant + Abemaciclib 100 mg BID + Zoladex (goserelin) + zoledronic acid (from January 2025)Completed
Bone progression in January 2025, after 12 months of goserelin + letrozole. Letrozole is replaced by fulvestrant and abemaciclib is added, at 100 mg BID from the start because of the earlier infection.
Bone progression (March 2026)Completed
The PET-CT (24 Mar 2026) confirms bone progression (increased uptake in pelvis and right femur; new foci in T1 and left iliac), with no visceral disease. Abemaciclib is stopped on 30 Mar 2026 for progression, coinciding with possible liver toxicity. Fulvestrant continues until 28 May 2026; goserelin continues.
SBRT to T11 (15–19 June 2026)Completed
Stereotactic radiotherapy to T11, the vertebra with anterior epidural extension on the spine MRI of 11 June 2026.
Fulvestrant + BG-75202 (KAT6A/B inhibitor), phase 1a/1b trial, with background goserelin (July–September 2026)Completed
From 15 July to 9 September 2026, at Vall d'Hebron. Screening imaging (July) already showed liver lesions: the metastases, until then bone-only (the breast primary is still present), were no longer confined to bone. She came off the trial on 9 September for clinical liver progression at 8 weeks: by RECIST 1.1 it was stable disease (sum of the four target lesions 68 → 74 mm, +8.8%, no new lesions: liver s.II 18 → 20 and s.IVb 15 → 19, breast 14 → 15, thoracic vertebra 21 → 20), but the liver lesions were growing, with worsening liver function, and CA 15-3 rose from 145 to 509.5 U/mL. The FDG-PET of 8 September describes liver and bone progression with new lesions. This exhausts the endocrine therapy options.
Datopotamab deruxtecan (Dato-DXd), anti-TROP-2 ADC · TROPION-Breast06 trial (NCT07205822)Active
Single-arm phase IIIb trial for HR+/HER2 IHC 0 breast cancer refractory to endocrine therapy and with no prior chemotherapy in the metastatic setting; Dato-DXd 6 mg/kg every 3 weeks. The liver biopsy confirms HER2 0 and PD-L1 CPS 0 (September 2026 reports). Screening from 1 to 6 October; the hospital documents her enrolment and schedules cycle 1 for 7 October 2026. Before this trial she had never received chemotherapy, ADCs, immunotherapy or radioligands. Performance status: ECOG 0 (October 2026). Background goserelin (last documented dose: 8 September 2026); zoledronic acid 4 mg every 3 months planned from cycle 2. RECIST baseline for the trial (6 October 2026): liver s.II 27 mm, liver s.VII 18 mm, breast 10 mm; sum 55 mm. It is not compared with that of the earlier trial: another centre and another baseline.
Clinical-history text, moved here from The science page unchanged. It is not yet in the data above, so its figures carry no separate seal.
The bone metastases reveal a target visible in vivo: they express SSTR+, the target of PRRT. Standard breast-cancer protocols do not consider this route.
PET with the 68Ga-DOTATOC radiotracer, which binds mainly the somatostatin receptor subtype 2 (SSTR2). Visualizes in vivo which lesions express SSTR2 and could therefore respond to radioligand therapy (PRRT).
«Study showing multiple blastic bone metastases with somatostatin receptor overexpression. Focal uptake in the right breast tail to be evaluated in a dedicated study.»
Clinical meaning: The bone metastases express somatostatin receptors, the target of radioligand therapy (PRRT). It is consistent with the neuroendocrine component seen on biopsy (the report only states somatostatin-receptor overexpression) and opens a route that breast-cancer protocols do not contemplate as standard.
Limits: the PET dates from May 2026, before the liver lesions appeared, so their SSTR status is unknown. Bone uptake was heterogeneous, with lesions showing no gallium. The FDG-PET of 8 September 2026 describes liver and bone progression, with new lesions; the same day, the CT and spine MRI report bone stability, so the bone progression is metabolic rather than morphological.
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.
1,924 lab values
From 73 blood draws since December 2023. Each dot is one; the 806 violet ones fell outside the range.
Tap a dot to read it.
in rangeout of rangeprogressiontreatment line
1,017 days
893 on a treatment line · 94 with no line running · 30 with an approximate date · 71 blood draws since diagnosis
Pick a day to read it.
1L2L3L4Lno 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
From diagnosis to today, full screen. Press play, pause, or drag the timeline.
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.
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 Vall d'Hebron ones (July to September 2026) are extracted from the lab's original PDF; the one from 6 October 2026 is a scanned preliminary report, read value by value from the image of the original. 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.