--- title: "Case timeline · Miriam González" canonical_url: "https://helpmiriam.com/en/timeline" last_updated: "2026-06-10T22:50:18.519Z" meta: description: "Miriam's case timeline, milestone by milestone: from diagnosis to the active search for a precision treatment with an international network." "og:description": "Diagnosis, treatments, progression and advances, milestone by milestone." "og:title": "Case timeline" "twitter:description": "Diagnosis, treatments, progression and advances, milestone by milestone." "twitter:title": "Case timeline" --- ## 2026 - May 30, 2026·**Molecular**** Latest**### **A new scan opens another door** Ga-68 DOTATOC PET-CT. Multiple blastic bone metastases with somatostatin receptor overexpression and focal uptake in the right breast tail. Confirms the tumor's "two sides" (luminal FGFR1/CCND1 + neuroendocrine RB1 + SSTR behavior) and opens the radioligand therapy path (PRRT). [**See the Ga-68 PET thread →**(opens in a new tab)](https://x.com/miriamgonp/status/2060649242037723567) - May 21, 2026·**Molecular**### **Experts from several countries review the case** The WIN Consortium international molecular tumor board meets to review Miriam's case. - May 17, 2026·**Outreach**### **The problem with the Spanish protocols** Video explaining why Spanish protocols fall short for this profile and a call to spread the case. [**Watch the video →**(opens in a new tab)](https://x.com/miriamgonp/status/2055872406858682514) - May 2026·**Third line**### **The third line is offered** With the ESR1 resistance mutation (D538G) confirmed in blood, elacestrant is offered as a standard 3rd line (public funding approved), pending start. In parallel, clinical trials and the radioligand route (PRRT) are evaluated. - May 13, 2026·**Molecular**### **The tumor keeps changing** Second blood ctDNA on the Guardant360 CDx panel. Results: ESR1 D538G (0.84%), CCND1 amplified (6.83), FGFR1 amplified (5.86), RB1 V622Yfs*33 (0.19%) and the new SMO V319D (0.26%) — clinical significance uncertain, under watch. - Apr 30, 2026·**Molecular**### **The needle finds no tumor** The needle reaches the lesion, but the sample collected is bone tissue, not active tumor. Results: mineralized bone trabeculae and skeletal muscle fibers, with no neoplastic cells. This does not rule out disease — it only confirms that tissue profiling can't be done through this route. The molecular picture keeps coming from ctDNA in blood. - Apr 20, 2026·**Outreach**### **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 →**(opens in a new tab)](https://x.com/miriamgonp/status/2046266823209890162) - Apr 13, 2026·**Molecular**### **A second reading confirms the profile** First blood ctDNA on the Guardant360 panel. Results: ESR1 D538G, 3 distinct RB1 mutations, FGFR1 amplified and CCND1 amplified. - Apr 8–9, 2026·**AI**### **Putting the whole case in writing** 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 →**(opens in a new tab)](https://x.com/javilop/status/2041905341059973294) - Apr 7, 2026·**Molecular**### **Reading the tumor without touching it** First plasma ctDNA within the HOPE-FOCUS SOLTI-2401 trial. Baseline profile of the tumor without needing tissue. Results: ESR1 D538G detected and low MSI status. [**See how the HOPE-Focus trial works →**(opens in a new tab)](https://clinicaltrials.gov/study/NCT06991946) - Apr 2026·**Team**### **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 three countries. [**See the original thread on Twitter →**(opens in a new tab)](https://x.com/miriamgonp/status/2041824144484917749) - Mar 2026·**Progression**### **Bone progression** The PET-CT of 24 Mar 2026 confirms bone progression (more uptake in pelvis and right femur; new foci in D1 and left iliac). On 30 Mar abemaciclib —always at 100 mg— is stopped due to the progression and mild hepatotoxicity that normalized once withdrawn. Zoladex and zoledronic acid continue; the search for the next strategy begins. ## 2025 - Jan 2025·**Second line**### **A change of plan after progression** Following confirmed progression on PET-CT, second-line treatment begins: letrozole is switched to fulvestrant and ribociclib to abemaciclib. Zoladex continued. ## 2024 - Jul 2024·**Molecular**### **The tumor reveals its molecular identity** Miriam participates in the DIPCAN study, enabling a complete genomic analysis of the tumor (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 tumor sample returns 5% at the local laboratory but 100% at the external reference laboratory — a difference with direct implications for hormonal treatment decisions. - Feb–Apr 2024·**Urgent admission**### **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.![Miriam in the ICU during her hospital stay. Intubated but looking divine, doing her skincare routine.](https://helpmiriam.com/.netlify/images?w=768&h=576&fm=webp&url=%2Fimg%2Fhospital.webp) - Jan–Feb 2024·**First line**### **The first treatment begins** 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. - Jan 11, 2024·**Diagnosis**### **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 33 years old. That same Tuesday, radiotherapy begins on the affected vertebrae. ## 2023 - Oct 31, 2023·**Symptoms**### **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. ## 2021 - 2021·**Background**### **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.*This timeline is updated weekly. You can follow the day-to-day in real time on X/Twitter.*[miriamgonp on X(opens in a new tab)](https://x.com/miriamgonp) [ Understand the science ](https://helpmiriam.com/en/science)