How To Treat Triple Negative Breast Cancer

What Is The Treatment For Triple Negative Breast Cancer

Healthcare providers and researchers are making significant progress on TNBC treatments. Recent clinical trials are testing new combinations of drugs and new approaches to existing treatments. Some existing treatments are:

• Chemotherapy: Providers might combine chemotherapy and surgery, with chemotherapy being used to shrink your tumor before surgery or after surgery to kill cancer cells throughout your body.
• Surgery: This could be a lumpectomy to remove an individual lump, or a mastectomy to remove an entire breast. Providers then perform a sentinel node biopsy or axillary node surgery to look for signs your breast cancer has spread to your lymph nodes.
• Radiation therapy: Post-surgery radiation therapy helps reduce the chances your cancer will return or recur.
• Immunotherapy: This treatment stimulates your immune system to produce more cancer-fighting cells or help healthy cells identify and attack cancer cells. Immunotherapy can be added to chemotherapy to before surgery to shrink the tumor. You might also receive immunotherapy for about a year after your surgery and post-surgery radiation therapy.

Early Stage Clinical Trials

In a proof of concept study published in the Lancet, authors investigated olaparib in patients with advanced metastatic breast cancer with germline BRCA1/BRCA2 mutations. They investigated two doses of olaparib at 400 mg BD and 100 mg BD. Approximately half of patients in this study had TNBC with the remainder having other histological subtypes. Patients were heavily pretreated with a median of 3 prior chemotherapy regimens and platinum sensitivity was not needed for trial enrolment. Overall response rates were impressive in this heavily pre-treated population at 41% in the group receiving the higher dose and 22% in the group receiving the lower dose.

Kaufman et al investigated olaparib further in a large phase 2 basket trial with 298 patients in a single-arm study. Patients with any advanced solid-organ malignancy were included if they harboured a gBRCA mutation. In the breast cohort, patients may have received multiple lines of treatment and there was no requirement for platinum sensitivity. Response rates were modest with only 8 of 62 patients responding in this unselected population.

How Do You Treat Triple

Due to the absence of hormonal receptors, triple-negative breast cancer does not respond to hormonal treatment. It also does not respond to treatments directed at HER-2 like trastuzumab.

Triple-negative breast cancer is treated with surgery, chemotherapy and /or radiation depending on the grade and the stage of the cancer. In fact, it may respond better to chemotherapy as compared to other cancers.

• The chemotherapy used for triple-negative breast cancer is the same as that for other breast cancers and includes anthracyclines and taxanes. Drugs like capecitabine, gemcitabine, vinorelbine or albumin-bound paclitaxel may be administered to those who develop resistance to the initial treatment. Newer drugs like eribulin and ixabepilone can be used in patients who do not respond to the above treatment.

• Given the high blood supply to the cancer, bevacizumab, a therapy directed against vascular endothelial growth factor may benefit patients with this type of breast cancer
• Chemotherapy is sometimes administered before surgery on the cancer to reduce the size of the tumor and improve outcomes following surgery. This type of treatment is called neoadjuvant chemotherapy. Chemotherapy may also be given following the surgery.
• Radiation therapy is also used in the treatment of triple-negative breast cancer.

Newer treatments under investigation will hopefully result in better outcomes for this cancer.

• Women over the age of 40 years are advised to undergo regular mammograms.

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Moffitt Cancer Centers Approach To Triple Negative Breast Cancer

At Moffitt Cancer Center, we believe in a multispecialty approach to breast cancer diagnosis and treatment. Our Don & Erika Wallace Comprehensive Breast Program comprises highly specialized medical oncologists, radiologists, fellowship-trained surgeons, radiation oncologists and other health care professionals who work together to provide our patients with well-rounded care. Our patients also have access to our supportive care services, which include counseling, integrative medicine, nutritional help and much more.

We continue to make strides in developing our understanding of triple negative breast cancer. Treatments are being evaluated regularly by medical researchers and clinicians as more is being learned about triple negative cancers. Our extensive research efforts and innovative clinical trials help our patients lead healthy and productive lives.

If you are interested in learning more about triple negative breast cancer treatment at Moffitt, call or complete a new patient registration form online.

How Triple Negative Breast Cancer Is Diagnosed

Breast cancer is often diagnosed using imaging tests and a biopsy. Some of the most common diagnostic tools for breast cancer include:

• Mammograms Digital mammography and full-breast tomosynthesis may be used to take X-rays of the breast from several angles.
• Breast ultrasounds During a breast ultrasound, penetrating sound waves make computerized pictures of the inside of the breast. Ultrasounds provide a much clearer image of breast tissue than mammograms and can define whether a mass is solid or filled with fluid.
• Magnetic resonance imaging An MRI is not always necessary to diagnose breast cancer, especially if the breast ultrasound was conclusive. But it can be a helpful screening tool for those with a higher-than-average risk for breast cancer.
• Biopsies Fine-needle aspirations, core-needle biopsies, stereotactic biopsies and surgical biopsies can be used to confirm a breast cancer diagnosis. During this procedure, tissue or fluid is removed from the breast and then analyzed under a microscope.

If breast cancer is the confirmed diagnosis after imaging tests and a biopsy have been done, the breast cancer cells will be sent to a lab to be analyzed. If the cells do not have progesterone and estrogen hormone receptors or an excess amount of the HER2 protein, the resulting diagnosis is triple negative breast cancer.

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What Are Symptoms Of Triple Negative Breast Cancer

TNBC symptoms are the same as other common breast cancers. And many breast cancer symptoms are similar to other less serious conditions. That means having certain symptom doesnt mean you have breast cancer. Possible breast cancer symptoms include:

• A new lump or mass.
• Swelling in all or part of a breast.
• Dimpled skin.
• Nipple retraction, when your nipple turns inward.
• Nipple or breast skin thats dry, flaking, thickened or red.
• Nipple discharge that is not breast milk.
• Swollen lymph nodes. This symptom happens when breast cancer spreads to the lymph nodes under your arm or near your collarbone.

Success Among Siteman Triple

In 2016, when Celina Campbell found a quarter-sized lump in her breast, she assumed it was just a swollen area due to a minor injury. However, breast cancer runs in Celinas family and her cousin had just received a TNBC diagnosis. Because of this, she began to suspect the lump could be cancer. After following up with a breast surgeon, it was indeed confirmed that Celina, too, had TNBC.

While triple-negative breast cancer treatment was very emotionally and physically draining, Celina remained determined to overcome her diagnosis. And, after eight sessions of chemotherapy, no more lump could be found. Now, six years later, Celina lives a full life and her cancer is considered fully cured.

Throughout her cancer journey, Celina received the most exceptional care and support from Sitemans breast cancer specialist team. Former Washington University medical oncologist William Popovic, MD, laid out a thorough and personalized treatment plan for Celina, putting her at ease with his warm demeanor and genuine concern. All of the staff dedicated themselves fully to Celinas journey, always working to help her understand her cancer and her treatment. The expertise, commitment and compassion of Washington University breast cancer specialists at Siteman allowed Celina to take charge of her life and to become an incredible inspiration to other TNBC patients.

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How Do Immunotherapy Antibody Drugs Work

Cancer cells want to survive, and they want to figure out a way to outsmart the body and one trick that they have is they say, well, why don’t I turn off the immune cells because the immune cells job is to find foreign things that don’t belong and so your immune system should be killing your cancer, but again, the cancer doesn’t want to be killed so it turns off this blocker, this PD-L1 receptor saying, “Hey, don’t kill me, immune system.” But these new antibodies can shut that blocker off so your immune system can be activated and kill your cancer.

I will say that it was a big thing for us to see a drug that’s going to finally improve survival for women with triple-negative breast cancer and so again, I think a very big breakthrough to have the availability of immunotherapy. Another really exciting change for triple-negative breast cancer is the first approval for an antibody-drug conjugate. The drug is called sacituzumab govitecan also known as IMMU-132.

The Trodelvy or sacituzumab govitecan, it’s a very clever drug because what it’s doing is it’s taking an antibody that’s targeting a receptor called the TROP2 receptor, which is on the vast majority of triple-negative breast cancers and tagged to that antibody is a very potent chemo drug. Lots of chemo drugs are tagged to that antibody, and so the antibody binds to the cancer cell that has that receptor on it and then that antibody gets taken into the cancer cell and releases the chemotherapy into the cancer cell.

When Should I Go To The Emergency Room

You might also have unusually strong side effects from your cancer treatment. While your healthcare provider likely gave you medication to help control your side effects, you should go to the emergency room if your side effects continue despite medication.

Many cancer treatments affect your immune system, increasing the chance you will develop infections. Symptoms that might require an emergency room visit during treatment are:

• Fever of 100.5 and above.
• Chills.
• Persistent nausea and vomiting.

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Management Of Tnbc: Evidence So Far

Despite it being a very heterogeneous disease, the treatment of patients with early TNBC is still founded on the administration of anthracycline/taxane-based chemotherapy. In a meta-analysis including women with hormone receptor -negative breast cancer treated in trials of non-taxane-based chemotherapy versus none, adjuvant chemotherapy reduced the 10-year risk of recurrence and breast cancer mortality . In a retrospective analysis of patients enrolled into 3 randomized trials of anthracycline/taxane-based chemotherapy, dose-dense anthracycline/taxane-based chemotherapy lowered the rate of recurrence and death by more than 50% compared to low-dose anthracycline-based chemotherapy in HR-negative, node-positive breast cancer . A meta-analysis using data of 100,000 women showed a reduced breast cancer mortality in patients receiving anthracycline/taxane-based chemotherapy. Proportional risk reductions were little affected by HR status .

Local Or Regional Treatments For Stage Iv Breast Cancer

Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.

Radiation therapy and/or surgery may also be used in certain situations, such as:

• When the breast tumor is causing an open wound in the breast
• To treat a small number of metastases in a certain area, such as the brain
• To help prevent bone fractures
• When an area of cancer spread is pressing on the spinal cord
• To treat a blood vessel blockage in the liver
• To provide relief of pain or other symptoms

In some cases, regional chemo may be useful as well.

If your doctor recommends such local or regional treatments, it is important that you understand their goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

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What You Need To Know

• Triple-negative breast cancer accounts for about 10% to 20% of all breast cancer cases.
• Every cancer diagnosis is unique, but in general, triple-negative breast cancer is a more aggressive type of tumor with a faster growth rate, higher risk of metastasis and recurrence risk. Therefore, it often requires chemotherapy as part of the treatment.
• Surgery is also an important part of treatment, but if a tumor is small and localized, mastectomy may not be necessary. Chemotherapy can shrink triple-negative breast tumors, and patients can become candidates for less-extensive surgery.
• Triple-negative cancers are more common in patients with hereditary genetic mutations, and genetic counseling and testing should be considered.

Is Keytruda Right For You

Keytruda is FDA-approved to treat certain types of triple-negative breast cancer.

Triple-negative breast cancer is breast cancer that is:

• estrogen-receptor-negative
• progesterone-receptor-negative
• HER2-negative

Triple-negative breast cancers are usually more aggressive, harder to treat, and more likely to come back than cancers that are hormone-receptor-positive or HER2-positive. Triple-negative breast cancers dont usually respond to hormonal therapy medicines or the medicines that target the HER2 protein.

Keytruda may be an option for people with triple-negative breast cancer that is:

• unresectable locally advanced breast cancer
• metastatic breast cancer
• early-stage breast cancer with a high risk of recurrence

Unresectable locally advanced breast cancer is breast cancer that has spread outside the breast to other tissues in the breast area. Unresectable means that it cant be removed with surgery.

Metastatic breast cancer is cancer that has spread to other parts of the body away from the breast, such as the bones or liver.

Keytruda also may be an option for people diagnosed with:

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How Siteman Approaches Triple

According to the American Cancer Society , triple-negative breast cancer accounts for 10-15 percent of all breast cancers. It develops more quickly, is more likely to spread and is harder to treat than other breast cancers. Because its such an aggressive cancer, TNBC has a poorer prognosis than other invasive breast cancers.

Causes Of Triple Negative Breast Cancer

The risk factors for triple negative breast cancer are not clear. Some breast cancers depend on hormones to grow. These can be linked with risk factors to do with hormones and having children. But triple negative breast cancer does not seem to share these risk factors.

Most women with triple negative breast cancer have no strong history of breast cancer in their family . But some women with triple negative breast cancer have an altered BRCA1 gene. This will have been inherited from a parent.

An altered BRCA 1 gene can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.

If you have triple negative breast cancer, you may be offered genetic testing. This is even if you do not have a family history of breast cancer. Your cancer doctor or breast care nurse can explain more about this to you.

The tests are the same as for any type of breast cancer. You usually have a:

• Mammogram

  A mammogram is an x-ray of the breast.

• Ultrasound scan

  An ultrasound scan uses sound waves to produce a picture of the breast tissue and the lymph nodes in the armpit.

• Breast biopsy

  When you have a breast biopsy, your cancer doctor or breast care nurse takes small samples of cells or tissue from your breast. The samples are looked at under a microscope to check for cancer cells. They also do other tests to find out if the cells have receptors for hormones, or for HER2.

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The staging and grading is the same as for other types of breast cancer.

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Inoperable Breast Cancer Is Often Still Treatable

Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.

If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.

Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.

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Statistics Dont Account For Late Recurrences

When comparing triple-negative breast cancer to positive tumors, its important to keep in mind late recurrences. Most statistics are presented as five-year survival rate, and in this setting, triple-negative breast cancer can look more ominous. But looking at longer periods of time, say 20 years following diagnosis, this may be different.

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How Do Treatment Options Differ Between Lumpectomies And Mastectomies

We know that if you get a lumpectomy, you do need radiation therapy. They go hand in hand, you need to radiate your entire breast. If we compare outcomes for someone who got a lumpectomy and radiation compared to a mastectomy, we know that the outcomes are the same, meaning the survival is going to be the same.

Generally speaking, if I have a patient who has a tumor that’s small enough for a lumpectomy, I do present them with a choice. Would you like to get a lumpectomy and radiation or choose a mastectomy? Again, we do have that choice left to the patient because again, from our standpoint, the outcomes to the patient will be the same.

The only case I will say that where this discussion also becomes a bit more complex is if someone has an underlying genetic mutation because then the issue isn’t just if I have my lumpectomy and radiation will this cancer come back, it’s also, could I get a new breast cancer in the breast tissue that’s left behind because I have a genetic predisposition and my chances of getting a new cancer are higher than the average patient. Should I get a mastectomy instead of a lumpectomy? Because I know that having a breast, in general, puts me at a higher risk for getting a new cancer.

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