Timeline
Week by week, every milestone matters
A first warning that went unanswered
Miriam goes to the emergency room due to bleeding in the breast. An ultrasound is performed. The result is normal. And that's where it ends.
Back pain begins
Miriam begins to notice persistent lower back pain. Weeks of physiotherapy and consultations with no clear answer. Until she requests an MRI herself.
The result arrives by email
The MRI report arrives by email on a Thursday morning. The conclusion: "probable vertebral metastases." No doctor present. No context. Just a screen. That same day, Miriam is admitted to the emergency room. The following Tuesday she receives the full diagnosis: stage IV breast cancer with neuroendocrine differentiation, multiple bone metastases, and spinal cord compression at L3. She is 32 years old. That same Tuesday, radiotherapy begins on the affected vertebrae.
Treatment: Letrozole + Ribociclib
First-line treatment begins with letrozole, ribociclib, Zoladex (goserelin), and zoledronic acid. After the first cycle, Miriam is urgently admitted with acute respiratory failure. Ribociclib is permanently discontinued.
50 days hospitalized, 10 in ICU
The severe neutropenia caused by ribociclib led to bilateral necrotizing pneumonia with areas of pulmonary necrosis. Miriam is admitted to the ICU with severe respiratory failure, critically low platelet counts, and the need for high-flow respiratory support. Bronchoscopy, transfusions, and intensive antibiotic therapy are required. Total hospital stay exceeds 50 days. This was the most critical moment since diagnosis.
The tumor reveals its molecular identity
Miriam participates in the DIPCAN study, enabling a complete genomic analysis of the tumour (TSO500). The results reveal the key markers: FGFR1 amplified ×13, CCND1 ×20, FGF3/4/19 ×18 (11q13 cluster). The analysis also detects a striking discrepancy in the progesterone receptor (PR): the same tumour sample returns 5% at the local laboratory but 100% at the external reference laboratory — a difference with direct implications for hormonal treatment decisions.
Treatment: Fulvestrant + Abemaciclib
Following confirmed progression on PET-CT, second-line treatment begins: letrozole is switched to fulvestrant and ribociclib to abemaciclib. Zoladex continued.
Bone progression — abemaciclib discontinued
PET-CT confirms new bone foci. Progression is the main reason for the change in strategy. Abemaciclib is also discontinued due to hepatic toxicity (DILI G2-3), though not severe. The rest of the treatment — Zoladex and zoledronic acid — continues. Active search for a third line begins.
The team forms and the search begins
Miriam begins researching her own case with artificial intelligence. A thread on Twitter. A few professionals who see it and say: I can help. Within days, a spontaneous multidisciplinary team forms with specialists from four countries.
See the original thread on Twitter →Clinical documentation generated with AI
A complete clinical summary of the case is generated using advanced language models. The document is designed for international second opinions and to communicate the case to high-level specialists.
See documentation thread →Talk at Codemotion Madrid
Miriam takes the stage at Codemotion Madrid to talk about how AI is helping advance her case. First public outreach event of the project and her return to the tech ecosystem after two years.
See the thread on Twitter →
This timeline is updated weekly. You can follow the day-to-day in real time on X/Twitter.
@miriamgonp