Youve Been Diagnosed With Triple
If youve received a TNBC diagnosis, you may be experiencing a range of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.
If you are experiencing symptoms that may point to breast cancer, or if you have received a TNBC diagnosis and would like a second opinion from a breast cancer specialist at Siteman, please call.
What Is The First Step In A Breast Biopsy
The first step might be a mammogram to evaluate a suspicious mass or lump in your breast. Based on what they learn, healthcare providers might perform a biopsy to remove breast tissue. Then they examine the tissues cells to determine the cancer subtype. Identifying the cancer subtype is part of the staging process, which is when providers decide how to treat your cancer.
Can You Have A Lumpectomy With Radiation
Some require lumpectomy only. Some require lumpectomy or mastectomy with radiation. Others get all that, plus lots of chemotherapy and sometimes immunotherapy. Triple negative breast cancer is different than mostpatients arent able to receive hormonal therapy, which can help prevent recurrence from happening.
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What Is The Treatment For Triple
Chemotherapy.Chemotherapy is almost always called for, Sun says. Chemo can downstage tumors . While Sun says the chemotherapy for triple-negative breast cancer can be intense, she adds that regimen can be tailored to the individual and adjusted for older or frailer patients.
In those cases where we get complete response, we know we gave you the right medicine and your prognosis is good, Sun says.
Surgery can remove more of the tumor. Surgery for triple-negative breast cancer does not always have to be a mastectomy, Sun says. Effective chemotherapy done first opens up the possibility of less-invasive surgical options that are less of an ordeal for the patient. If the tumor is small enough after chemo, outpatient procedures or a lumpectomy may be possible.
Surgical samples of the cancerous tissues taken from surgery can provide more information on the cancer and how it is behaving so chemotherapy can be tailored accordingly.
Radiation therapy involves the use beams of radiation to destroy cancer cells, using various techniques to prevent damage to healthy surrounding tissue.
Medical treatments are being tested on triple-negative breast tumors in clinical trials.
Immunotherapy and PARP inhibitors are very exciting and theres lots of research going on, including here at Johns Hopkins, Sun says.
How To Reduce Racial Disparities In Metastatic Triple
More research is needed to find the driving force behind these inequities. But here are some steps you can take to improve your cancer care right now:
Ask about genetic testing. Your odds of TNBC go way up if you test positive for the BRCA1 gene mutation, so tell your doctor if you have a strong family history of breast or ovarian cancer. Theyâll help you find out if genetic counseling or testing is right for you.
Once you know you have a genetic mutation, you can act on that information. Ask your doctor about preventive strategies to manage your breast cancer risk.
Bring up breast density. Not everyone with dense breast tissue gets breast cancer. But if youâre a Black woman at higher risk of TNBC, you might benefit from breast MRIs or more frequent breast cancer screenings.
Talk to a patient navigator. These are people on your cancer team who can help you overcome personal barriers to treatment. Theyâll set up child care, rides to appointments, copay assistance, or financial aid.
Ask your doctor who to talk to or reach out to the Patient Advocate Foundation. Thatâs a nonprofit group that gives professional case management services to people with chronic or life-threatening illnesses like cancer.
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Trials For Advanced Triple Negative Breast Cancer
Trials are comparing different types of chemotherapy to see which are better at treating advanced disease. For example, researchers are waiting for the results of the Triple Negative Trial to find out whether it is better to use carboplatin or docetaxel.
Research is looking at using targeted cancer drugs alongside other treatments. For example, a trial is using a drug called atezolizumab in combination with chemotherapy. Some trials are testing a drug called pembrolizumab. Researchers think that these targeted drugs on their own might help to control the growth of the cancer.
A New Treatment Option Is Now Available
On March 11, 2022, the Food and Drug Administration approved a drug called Olaparib to treat HER2-negative, high-risk early breast cancer. Data from a phase 3 clinical trial of 1,836 patients, of which about 82% had the triple-negative disease, led to the approval. The clinical trial results demonstrated that Olaparib reduced the risk of death by 32%, compared to the placebo. The recent FDA approval brings new hopes to patients with early triple-negative breast cancer since many currently available therapies couldnt effectively control the progression of their cancers.
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Tnbc Treatment Options At Siteman
As a TNBC patient, making treatment decisions can be stressful. At Siteman, our exceptional providers offer a variety of triple-negative breast cancer treatment options:
- Surgery: oftentimes, patients first need to have either the lump removed or the entire breast removed . Then, they will receive chemotherapy to target any remaining cancer cells.
- Chemotherapy: because hormone therapy and HER2 drugs arent effective treatment options for women with TNBC, chemotherapy is the main systemic treatment option. Patients may receive chemo prior to surgery , either by itself or with pembrolizumab to shrink a large tumor. Patients may also receive chemo after surgery to reduce the chances of recurrence.
- Targeted drugs: for women with TNBC who have a BRCA mutation and whose cancer no longer responds to more common breast cancer chemo drugs, their treatment teams may turn to other chemo drugs or targeted drugs .
- Radiation therapy: radiation usually comes after lumpectomies or mastectomies. High-energy radiation targets the breast to kill any remaining cancer cells. The process takes about 20 minutes. Most women receive radiation four to five days a week for about six weeks.
About Huntsman Cancer Institute At The University Of Utah
Huntsman Cancer Institute at the University of Utah is the official cancer center of Utah and the only National Cancer Institute-designated Comprehensive Cancer Center in the Mountain West. The campus includes a state-of-the-art cancer specialty hospital and two buildings dedicated to cancer research. Huntsman Cancer Institute provides patient care, cancer screening, and education at community clinics and affiliate hospitals throughout the Mountain West. It is consistently recognized among the best cancer hospitals in the country by U.S. News and World Report. The regions first proton therapy center opened in 2021 and a major hospital expansion is underway. Huntsman Cancer Institute is committed to creating a diverse and inclusive environment for staff, students, patients, and communities. Advancing cancer research discoveries and treatments to meet the needs of patients who live far away from a major medical center is a unique focus. More genes for inherited cancers have been discovered at Huntsman Cancer Institute than at any other cancer center, including genes responsible for breast, ovarian, colon, head and neck cancers, and melanoma. Huntsman Cancer Institute was founded by Jon M. and Karen Huntsman.
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Dsfcu Complex For Tnbc Therapy
TNBC represents an aggressive subtype, for which radiation and chemotherapy are the only options . Acquired chemoresistance remains the primary cause of therapeutic failure of TNBC . In the clinic, the relapsed TNBC is commonly pan-resistant to various drugs with entirely different resistance mechanisms. Investigation of the resistance mechanisms and development of new drugs to target pan-chemoresistance will potentially improve the therapeutic outcomes of TNBC patients .
The MDA-MB-231PAC10 cell line is made up of a high population of cells expressing stem cell markers that may play a vital role in the pan-resistance. These cells express high ALDH activity and a panel of embryonic stem cellrelated proteins and nuclearization of HIF2a and NF-kBp65. These cells are highly cross-resistant to PAC, cisplatin , docetaxel, and doxorubicin. DSF was reported to abolish CSC characters and completely reverse PAC and CDDP resistance in MDA-MB-231PAC10 cells . In addition, DSF/Cu exposure for 4 h leads to inhibition of both ALDH activity and expression of Sox2 and Nanog in the resistant cells. In combination with DSF/Cu, the cytotoxicity of PAC and CDDP in MDA-MB-231PAC10PAC10 cells was significantly higher than PAC, CDDP, or DSF/Cu single-drug exposure. The cytotoxicity of DSF/Cu plus PAC was synergistic in a wide range of concentrations .
Chemotherapy For Triple Negative Breast Cancer
Chemotherapy is often recommended for treating triple negative breast cancer. Unlike most other types of breast cancer, triple negative breast cancer does not respond to the presence of certain hormones, such as estrogen and progesterone, nor does it have an abnormally high level of HER2 receptors. Therefore, hormone therapy is largely ineffective for treatment purposes. Nevertheless, triple negative breast cancer often responds very well to chemotherapy.
Depending on when chemo is administered, its goals can vary. For instance, chemotherapy may be recommended prior to surgery to attempt to destroy rapidly dividing cancer cells. In this way, it may be possible to shrink tumors and make them easier to remove, which can increase the likelihood of a successful surgical outcome. Additionally, because it is not always possible for a surgeon to completely remove a patients cancer, chemotherapy may be recommended after surgery to target any remaining cancer cells and help prevent spread and recurrence. Alternatively, chemo can be used as a primary form of treatment to control the growth and ease the symptoms of large tumors that cannot be surgically removed.
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Infused into a vein through an intravenous drip
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Injected by needle into a vein or muscle
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Taken by mouth in pill or capsule form
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Swallowed in liquid form
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What Are The Chances Of Surviving Triple
In general, about 91% of all women with triple-negative breast cancer are still alive 5 years after diagnosis. If the cancer has spread to the lymph nodes near the breast the 5 year relative survival rate is about 65%. If the cancer has spread to distant places, the 5 year relative survival rate is 12%.
Research Progress And Future Questions
After the 2020 approval of the combination of pembrolizumab and chemotherapy for advanced triple-negative breast cancer, FDA approved the combination therapy for people with early-stage disease in 2021.
That approval was based on results from a different trial, KEYNOTE-522. In that study, patients with high-risk, early-stage triple-negative breast cancer benefited from pembrolizumab given with chemotherapy before surgery, and then continued as a single agent as an additional, or adjuvant, treatment after surgery.
This is an exciting time for research on triple-negative breast cancer, said Dr. Lee. We have now seen a benefit from an immune checkpoint inhibitor and chemotherapy in a subgroup of patients in both the advanced and early stages of the disease.
Dr. Lee cautioned, however, that more than half of all patients with triple-negative breast cancer have PD-L1 combined positive scores of less than 10, so more work is needed to find effective treatments for these patients.
In his editorial, Dr. Pivot noted that people diagnosed with triple-negative breast cancer are not a homogeneous group. Future studies, he added, will try to identify which individuals are more or less likely to benefit from pembrolizumab.
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Family History And Metastatic Triple
All breast cancers are tough to get rid of once theyâve spread to other parts of your body. But mTNBC presents more of a challenge because there are no hormones to target. But the number of therapies available is growing. And while your family history doesnât directly affect treatment, your genes and the genes in your tumor may change the kind of anti-cancer drugs your doctor uses.
For example, you may benefit from standard treatment along with newer drugs like immunotherapy, drug-antibody conjugates, or PARP inhibitors.
âThe mainstay of treating triple-negative breast cancer is chemotherapyâ Lee says. âBut thereâs a lot of work going on to try to find new agents and new combinations of agents to improve treatment.â
How Common Is Triple
About 10 to 20% of breast cancers are found to be triple-negative. However, triple-negative cancer cells are found more often in people under the age of 50. This is about 10 years younger than the average age of 60 or older for other types of breast cancer diagnoses. Triple-negative breast cancer is also found in higher percentages of Black and Hispanic patients and less often in Asian and non-Hispanic patients.
Another population that is more likely to be diagnosed with this type of breast cancer has an inherited mutation of the BRCA gene. About 70% of those with triple-negative breast cancer also test positive for having the BRCA mutation. You may qualify for genetic testing based on your family history. Learn more about genetic testing for breast cancer.
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What Is Triple Negative Breast Cancer
Triple negative breast cancer is a rare cancer that affects about 13 in 100,000 women each year. It represents about 15 % of all invasive breast cancers. Triple negative breast cancer is one of three types of breast cancer. It is called as triple negative because it doesnt have three markers associated with other types of breast cancer, which is important for prognosis and treatment. Its one of the more challenging breast cancers to treat. But researchers are making steady progress toward more effective treatments. Overall, 77% of women who have triple negative breast cancer are alive five years after diagnosis.
What Research Trials Are Underway
There are several new and ongoing studies looking at treatments for triple-negative breast cancer.
Dr. Fancher encouraged people with triple-negative breast cancer to look into trials. Research on clinical trials is really important, she told MNT.
If you triple-negative breast cancer, consider a clinical trial. It helps move the research forward. There are lots of trials out there, and many are having good results.
Dr. Nan spoke about the Keynote 522 clinical trial . This trial is looking at the use of pembrolizumab, a type of immunotherapy, in combination with chemotherapy before and after surgery.
The trial focuses on people with stage 2 or 3 breast cancer who are at high risk, and pembrolizumab has shown some promise. In fact, the trial has shown a 65% effectiveness rate, indicating no residual signs of cancer in the tissue. This is up from 51% previously.
The phase 3 ASCENT clinical trial is looking at the use of sacituzumab govitecan, an antibody drug conjugate. In a phase 2 trial, it had shown promise in people who had previously received treatment for metastatic triple-negative breast cancer. The Food and Drug Administration gave the drug accelerated approval in 2020.
A person should talk with a doctor before joining a clinical trial. They may be able to help the person find a relevant study or recommend ones that will work best for them.
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Why Do Black Women Get Triple
Around 15% to 30% of all breast cancers in Black women are triple-negative. According to Anne Marie McCarthy, PhD, a cancer epidemiologist and assistant professor at the University of Pennsylvania, TNBC rates are around 5% to 10% for non-Hispanic white women.
While itâs clear there are large racial disparities in rates of TNBC, âweâre not sure why that is,â McCarthy says. âAlthough, we have some ideas.â
Age and breast tissue density. TNBC is found more often in Black women younger than 55 who have very dense breasts. This fibrous tissue can cause an added issue with mammograms, and these machines may have a hard time snapping shots of TNBC tumors early on in these women.
Reproductive habits. Unlike other kinds of breast cancer, the odds of TNBC appear to go up with the number of babies you have. Breastfeeding seems to lower some of that risk, but Black women are typically less likely to breastfeed or may not breastfeed for as long as other groups.
Obesity. Thereâs some evidence it may fuel the kind of inflammation that leads to TNBC. And Black women tend to have higher levels of body fat than some other groups. But the research on the link between higher body mass index and TNBC is mixed.
Itâs important to note that people with obesity who are diagnosed with any kind of breast cancer generally have poorer health outcomes no matter their race or ethnicity.
High Rates Of Glucose Metabolism In Tumors
Researchers have focused attention on abnormally high rates of glucose metabolism in tumors, first discovered nearly a century ago. However, for the new Nature Medicine study the scientists used a technique called mass spectrometry to identify metabolites associated with triple-negative breast tumors that arose in mice when MYC expression was abnormally elevated. In collaboration with the research group of Daniel K. Nomura, PhD, associate professor of chemistry and of nutritional sciences and toxicology at UC Berkeley, they found an unusual abundance of fatty acid oxidation metabolites, indicating that triple-negative breast cancer cells may be oxidizing fat to satisfy their energy needs.
In addition to studying these transgenic mice that had a switchable MYC gene, the researchers worked with human tumor tissue, with clinical data from The Cancer Genome Atlas and other public databases, and with tumor cells growing in the lab. UCSF graduate student Roman Camarda designed and conducted most of the experiments and wrote up the study for publication.
In triple-negative breast cancer cells with increased MYC activity grown in the lab, etomoxir inhibited production of the molecule ATP, the common energy currency of cells, but did not have the same effect on other types of breast cancer cells.
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