A Brother's Gift: Supporting Research in Triple Negative Breast Cancer

It was on the third climb of five Sierra Nevada Mountain passes that Rakesh Marwah, MD, thought to himself that he wasn’t going to make it.

This was the first time the self-described “casual cyclist” had done a ride of this magnitude. The Death Ride— one of the top cycling events in the West with its 129 grueling miles and 15,000 feet of vertical climbing—was living up to its name as a “lung-buster.”

“The climb took well over an hour, so there was lots of time to think about various things,” says Dr. Marwah, a Stanford anesthesiologist. In the middle of the climb, and struggling with the altitude, he started thinking,

“I don’t think I can finish.”

And then, he remembered a piece of advice he had received from a friend who attempted the same ride years before, but who had not finished it.

“You need to pace yourself,” the friend had said. “Just like your sister had to go through the pain of chemo and all of her treatment, she paced herself and made it through. You can, too.”

“I kept thinking about her words. So it was just, pace. Focus on pacing. That was really helpful. It was one of the things that really helped push me through,” says Dr. Marwah. “I thought to myself, if Shelley can put in the work and plough through all her treatment, I can put in the work and plough through the climb.”

For months, Dr. Marwah had been looking for a way to help bring attention to triple negative breast cancer, a particularly aggressive disease. Responsible for a large percentage of cancer deaths because it resists traditional chemotherapy, it gets its name from its lack of three receptors typically used as treatment targets—estrogen, progesterone, and a growth factor called HER2. Beyond being notoriously difficult to treat, triple negative breast cancer—which makes up 15 percent of all breast cancer—is more likely to recur than other types.

When the unexpected diagnosis came for his sister, Shelley, “I suggested we find a physician whose expertise is specifically in triple negative,” says Dr. Marwah. He knew that Stanford had a world-class facility in oncology, and he discovered that Melinda Telli, MD, assistant professor of oncology, is one of the nation’s leading experts in the disease. He contacted Dr. Telli and told her about Shelley.

“Bring her to me,” Dr. Telli told him.

Dr. Telli’s research focuses on breast cancer treatment and survivorship, and in developing new strategies for the treatment of early stage triple-negative and BRCA1/2 mutation-associated breast cancer. She leads clinical trials that promise to be in the vanguard of personalized medicine, matching drug treatments to an individual’s cancer based on its genetic makeup and molecular profiles. The risk of spread with this aggressive form of breast cancer is substantial, yet long-term side effects of therapy are also possible. Dr. Telli also investigates the prevention of cardiac damage associated with breast cancer treatment and cardiotoxicity of anti-cancer agents.

“I went to almost all of my sister’s appointments. Being the physician in the family, I tried to process all of the medical information. Yet I wasn’t there in a clinical capacity as a physician, but as a supportive family member. And I think that allowed me to have different perspectives in interpreting and understanding Dr. Telli and her practice.

“I found Dr. Telli to be a physician who was kind, intelligent, and receptive, yet direct and concise. She had an ability to deliver at times very difficult information. And her ability to deliver that in a very sensitive, caring, yet professional manner left a positive impression on me,” he says. “She was absolutely thorough. She was able to be confidence-inspiring, yet had a sense of humility.”

From the time of Shelley’s diagnosis until she was finished with all of her near-term treatment and was recovering well, there was a feeling that the family wanted to do something to say thanks.

“Something in order to give back, something to call attention to the need, something that would rally or inspire others,” says Dr. Marwah. “There was a variety of ideas that we sort of kicked around.”

He had been cycling more often with a friend of his, Ryan Derby, MD, who is also an anesthesiologist at Stanford. Dr. Derby had tackled the Death Ride twice before.

While this was a one-day ride, the real ride had been the last two years. There was a one-day struggle that had so many parallels to the last two years of struggle.

“Once he convinced me that this ride was feasible, that was when the two thought processes came together for me. I thought, if this ride is actually doable, it would a good avenue for me to build a fundraiser around it,” says Dr. Marwah. “It would be an opportunity to thank Dr. Telli and raise money for her work, and help promote research and development in triple negative breast cancer.”

The two trained together at the gym and, on weekends, doing more lengthy rides in the local hills. Once they hit the two-month mark, they started doing interval training during the week.

“Ryan and I would do longer rides geared to a fair amount of climbing and distance, a lot of it just getting used to being on a bike for a long period of time. On the weekends, we did all the classic big climbs around here: La Honda, Kings Mountain, Tunitas, Stevens Creek.

“We didn’t do any altitude training. Except the weekend before—the July 4 weekend—we thought we might as well take advantage of the long weekend. We rode around Lake Tahoe, which was beautiful.”

On the morning of the Death Ride, he started out at 4:45 a.m., one of 3,500 people who geared up in the tiny town of Markleeville in Alpine County.

“The way the town comes together to be supportive of everyone—from people who are fast and just crushing the ride, to the people who are limping along, to those who are injured and Life Flighted from crashes—is inspiring.

“It was nice to see people come together to help each other and get through, cheering each other on when they were down. It reminded me a lot of what had happened in the last two years,” he says.

“While this was a one-day ride, the real ride had been the last two years. There was a one-day struggle that had so many parallels to the last two years of struggle.”

He powered through that third mountain pass, then the fourth, and finally the fifth: 14 hours and 13 minutes after he started. Dr. Marwah’s efforts on behalf of his sister raised more than $10,000 and a greater awareness for Dr. Telli’s work at Stanford.

“In reality, it was just a bicycle ride. And we all chose to be there. But there’s so many struggles in life where people don’t get to choose. Cancer being an obvious one.”

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