What Chemo Drugs Are Used For Triple Negative Breast Cancer

Home Remedies And Lifestyle

If you have had any of the standard therapies for TNBC, you may experience symptoms due to your cancer or as side effects of treatment.

There are a number of strategies you can use at home to alleviate your symptoms:

• Ice packs: Some women experience pain or swelling after breast cancer surgery or due to radiation. Ice packs, when used carefully, can help.
• Massage: You may have pain, aches, or soreness. If approved by your doctor, using a massaging device may be soothing.
• Exercise: Often, exercise can help reduce the swelling that follows a mastectomy or an axillary dissection. If swelling is a persistent problem for you, talk to your doctor about starting some regular exercises that you can do on your own. Often, keeping your arm lifted while it is resting is also recommended.
• Armband: For some women, a snug wrap around the hand or arm can help reduce the swelling that occurs after breast cancer surgery.
• Diet: You can experience a loss of appetite due or nausea to chemotherapy. And sometimes, TNBC can be so aggressive that it causes malnourishment and weight loss. You may need to work with a dietitian to make sure that you are getting a healthy balance of nutrients.
• Fluids: Drinking fluids such as water, ginger ale, or electrolyte drinks can help replenish you when mild dehydration is a problem . Ginger ale also counteracts mild nausea.

Possible Side Effects Of Chemo For Breast Cancer

Chemo drugs can cause side effects. These depend on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:

• Hair loss

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

• Increased chance of infections
• Easy bruising or bleeding
• Fatigue

These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.

Update On Strategies To Improve Treatment For Triple Negative Breast Cancer

Approximately 12% of all breast cancers are TNBC, meaning that they are estrogen-receptor negative , progesterone-receptor negative , and human epidermal growth factor receptor 2-negative . This means that TNBC is not stimulated to grow from exposure to the female hormones estrogen or progesterone, nor through an overactive HER2 pathway.

Unfortunately, many available and effective treatment options for the majority of breast cancers block the growth stimulating effects of ER, PR and/or HER2; therefore, TNBC has had limited therapeutic options.

In addition, TNBC tends to be an aggressive type of cancer, is often diagnosed at a more advanced stage, and proportionately affects younger women more often than other breast cancers. Novel treatment options for TNBC have lagged behind that of other types of breast cancers.

The development of more effective treatment for triple negative breast cancer requires that new and innovative therapies be evaluated in TNBC patients. Areas of active investigation aimed at improving the treatment of TNBC include some of the following:

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Risk Factors For Triple

Doctors aren’t sure what makes you more likely to get triple-negative breast cancer. Not many women do — it only affects up to 20% of those who have breast cancer. You’re most at risk for triple-negative breast cancer if you:

• Are African-American or Latina
• Are under 40
• Have what your doctor will call a BRCA mutation , especially the gene BRCA1

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.

• National Institute for Health and Care Excellence , July 2018

• Biology and management of patients with triple negative breast cancerP;SharmaThe Oncologist. 2016, Volume 21, Issue 9

• 4th ESOESMO International Consensus Guidelines for Advanced Breast CancerF Cardoso and othersAnnals of Oncology,2018, Volume 29, pages 16341657

• Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upF Cardoso and others;

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Ethics Approval And Consent To Participate

The human study protocol was approved by Comité de Ética de la Investigación con Medicamentos , Hospital General Universitario Gregorio Marañón. The IiSGM Animal Care and Use Committee and Comunidad de Madrid approved all the PDX procedures . Procedures involving animal care complied with national and international laws and policies. The collection of samples was approved by the corresponding ethics committee . Patients provided written informed consent before any procedure.

Brca1/2 Mutations And Homologous Recombination Deficiency

DNA damage in cells, caused by extracellular agents or endogenous events, is repaired by various DNA repair mechanisms. Those are base excision repair , nucleotide excision repair, mismatch repair, and double-strand break repair that includes either homologous recombination during the S and G2 cell cycle phases and nonhomologous end joining. BRCA1/2 is directly involved in DNA homologous recombination repair and plays an essential role in genome stability. Mutations in BRCA1/2 or other homologous recombination defects result in growth defects and genetic instability. Germline BRCA1/2 mutations are present in approximately 10% to 20% of patients with TNBC, especially in those aged <60years.- The presence of these mutations is associated with hereditary breast and ovarian cancer syndrome. Almost all the known BRCA1 mutations have gene expression patterns coincident with basal-like subtype. BRCA2 mutation is more associated with lobular histology. Testing for germline BRCA1/2 mutations is essential in patients with mTNBC to predict future cancer risk and guide therapeutic strategies.

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Adjuvant And Neoadjuvant Drugs

• Ixabepilone
• Eribulin

Although drug combinations are often used to treat early breast cancer, advanced breast cancer more often is treated with single chemo drugs. Still, some combinations, such as;paclitaxel plus gemcitabine, are commonly used to treat advanced breast cancer.

For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.

Targeted Therapy For Her2

In about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as HER2 on their surface. These cancers, known as HER2-positive breastcancers, tend to grow and spread more aggressively. Different types of drugs have been developed that target the HER2 protein.

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The Need For Alternative Treatments

Professor Judith Bliss, director of the Clinical Trials and Statistics Unit at the ICR, who led the management of the study, said: Women with triple-negative breast cancer often only survive for one to two years after the cancer has relapsed and spread to other parts of the body, so there is an urgent need to find alternative treatments for this group of patients.

Our study has shown that this doesnt have to mean developing new drugs. We can use existing and often cheaper, generic drugs more effectively by targeting treatment based on weaknesses in individual patients tumours.

Keytruda Effective As Neoadjuvant Treatment For Tnbc

Keytruda is a fully humanized monoclonal antibody checkpoint inhibitor that binds with high-affinity to the PD-1 receptor. Results in advanced breast cancer have been mixed. In heavily pretreated patients with recurrent or metastatic TNBC positive for PD-1 Keytruda has been reported to produce a response rate of 18.5% however a trial directly comparing single agent Keytruda to chemotherapy in recurrent TNBC found that Keytruda was no better.2

Chemotherapy administered before surgery with the goal of reducing the size of the cancer for surgical removal is called neoadjuvant chemotherapy. Use of Keytruda earlier in the adjuvant and neoadjuvant setting may hold more promise. Neoadjuvant Keytruda was reported to be significantly more effective than chemotherapy at eradicating cancer confined to the breast prior to surgery.3 These results are consistent with the I-SPY 2 clinical trial which demonstrated that Keytruda in combination with standard therapy as neoadjuvant treatment for patients with locally advanced TNBC increased the pathologic complete response nearly threefold in patients with TNBC.5

This was confirmed in the KEYNOTE 522 clinical trial which enrolled 1,174 patients with locally advanced TNBC to receive treatment with standard chemotherapy with or without the addition of Keytruda followed by definitive surgery and radiation therapy. After completion of local therapy patients were treated with additional Keytruda.

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Why Targeted Therapy Can’t Be Used

Targeted therapies take aim at cancer cells by interfering with the activity of receptors that fuel cancer growth. For example,;tamoxifen;and;aromatase inhibitors;target estrogen receptors. Herceptin targets HER2 receptors. These treatments are effectivebut only if a cancer tests positive for such receptors. As TBNC, by definition, is negative for them, the disease will not respond to targeted therapies.

What About Hdc And Asct

One of the largest and best controlled clinical trials evaluating the use of high-dose chemotherapy and autologous stem cell transplant to treat patients with early stage breast cancer and more than 9 involved axillary lymph nodes continues to show survival benefit 20 years from receiving treatment. In fact HDC was associated with improved overall survival in the subgroup of women with triple-negative breast cancers: 52.9% of these patients were alive at 20 years compared with 37.5% of those in the conventional-dose chemotherapy.11

In the 1990s HDC and ASCT was increasingly used to treat breast cancer and other solid tumors based on its success in curing certain individuals with lymphoma, leukemia, and multiple myeloma. HDC continue to be the standard of care for many cancers but became out of favor as a treatment option for breast cancer due to conflicting study results and concerns about side effects.

The use of HDC for the treatment of breast cancer was based on the idea that breast cancer treatment could be improved if higher doses of chemotherapy could be administered and this has been borne out to be true. A standard treatment for high risk early stage breast cancer today is dose-dense chemotherapy which is widely used instead of HDC and ASCT and requires the use of blood cell growth boosters to ensure the chemotherapy can be safely administered in a timely manner.

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Do I Need Genetic Counseling And Testing

Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.

If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.

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Axillary Lymph Node Dissection

An;axillary lymph node dissection;is done when cancer has spread to nearby lymph nodes. It is usually done at the same time as a lumpectomy or mastectomy.

Your surgeon may remove some lymph nodes or all of the nodes located in the axilla .;Samples of tissue from these nodes are sent to a pathology lab for testing.;

The report will provide information about whether your lymph nodes have breast cancer cells. This will be helpful in determining the stage of your cancer and whether you will need more treatment.

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What Is Triple Negative Breast Cancer

Triple negative breast cancer is a less common type of breast cancer. It develops in about 1 in 5 women with breast cancer . It is more common in women under 40. It also seems to be more common in black women.

We need further research to understand this more. But triple negative breast cancer can develop in women of any age and ethnicity.

Breast cancer cells may have receptors; that hormones or a protein called HER2 can attach to. A specialist breast cancer doctor takes a sample of cancer cells during a biopsy orsurgery to test for these receptors. If these receptors are found, you are usually treated with hormonal or targeted therapies.

Triple negative breast cancer does not have receptors for hormones, or HER2. This means treatment with hormonal or targeted therapy will not work.

Chemotherapy, along with surgery and radiotherapy, is the most effective treatment for triple negative breast cancer.

Triple negative breast cancer is sometimes described as a faster growing type of breast cancer. This may make you feel worried about it coming back. But the risk of it coming back depends on the same factors as any other type of breast cancer.

What Is The Five

This depends on how advanced the cancer is. According to the National Cancer Institute, the five-year relative survival rate for TNBC is:

• 91% if the cancer is localized
• 65% if the cancer is regional
• 12% if the cancer has metastasized to areas far away from the breast, such as the bones, lungs, or liver
• 77% for all stages combined

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Why It Gets Accelerated Approval

The FDAs accelerated approval is granted for certain drugs that treat serious conditions and fill an unmet need. The manufacturer of the drug is still required to conduct additional trials and is expected to submit more findings by September next year. Upon those results, the drug could garner traditional approval.

When breast cancer cell growth isnt triggered by estrogen, progesterone, or human epidermal growth factor 2 , its known as triple-negative breast cancer. This type of breast cancer is considered aggressive with poor prognosis.

It doesnt respond to hormonal cancer treatments that have helped improve survival rates for people with other forms of the disease. However, it does respond to chemotherapy, but cancer cells can develop a resistance to chemotherapy agents. The treatment can also be very difficult on the patient as it kills off healthy cells along with cancer cells.

Triple-negative breast cancer is most likely to affect Hispanic and African-American women, along with people who have the BRCA1 gene mutation. It can develop in women in their 40s and 50s.

Approximately 15 percent of breast cancers are triple-negative, the National Breast Cancer Foundation reports.

About one-fifth of people with triple negative breast cancer have the PD-L1 protein, which is what atezolizumab targets.

Tecentriq Improves Survival In Advanced Tnbc

Tecentriq is another checkpoint inhibitor and whencombined with Abraxane in women with advanced TNBC produced an anti-cancer response in 70.8% of patients.5 The combination of Tecentriq and Abraxane improved average survival duration from 15.5 months among patients with PD-L1positive tumors compared to 25 months compared to Abraxane alone, leading to accelerated FDA approval.8,9

Treatment combinations consisting of checkpoint inhibitors plus Abraxane and other known active drugs in TNBC like Gemzar and Carboplatin are ongoing to determine the optimal way to incorporate this new class of drugs into the overall management of TNBC.6

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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.

See also

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