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About 15% of all breast cancer cases are Triple Negative. It is considered the most aggressive and treatment-resistant, cancer often recurring soonest if treatment fails. Since traditional chemo treatments focus on and target hormone-positive cancers, they dont have much to offer in terms of TNBC. TNBC cells dont have receptors for estrogen, progesterone, and Her2/neu, so they have nothing to grab onto. Additionally, since it is a less-targeted treatment, it is even more toxic to the body. But this doesnt mean it is all gloom and doom.
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.
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.
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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.
Historically, most 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 affects younger women more often than other breast cancers. Novel treatment options for TNBC have lagged behind that of other types of breast cancers but the treatment landscape is improving.
When patients are newly diagnosed with TNBC, they should undergo NGS-biomarker testing to check for PD-L1 status, BRCA and other biomarkers that can identify individuals who can benefit from treatment with newer precision cancer medicines and immunotherapy.
What Is The Estrogen Receptor And How Is It Linked To Breast Cancer
On the surface of cancer cells is a specialized receptor called estrogen, which acts as a hand, consuming hormones from the body and using them as fuel to thrive. TNBC can survive without these receptors because it has a whole new survival mechanism. Estrogen receptor and progesterone receptor are predictive markers for invasive breast cancer, especially within five years of initial diagnosis.
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Who Is Most Likely To Have Tnbc
Triple negative breast cancer appears more frequently in women age 40 and younger than in older women. Black and Latina women are more likely to develop TNBC than white women. Women who have the gene change BRCA1 are more likely to develop TNBC than other women. When the BRCA1 gene mutates, it stops preventing cancer and appears to make your bodys cells more vulnerable to cancer.
How Is Tnbc Diagnosed
Imaging tests are usually the first tests done:
- Mammography, the most common screening tool for breast cancer, uses X-rays to take images of the breast and can uncover tumors that may be too small to feel.
- MRI uses a magnet, radio waves and a computer to make detailed images of the breast with a much greater resolution than a mammogram offers.
The next step is a biopsy to remove a sample of suspicious cells from the breast to analyze them. Techniques include:
The appropriate type of biopsy for you depends on factors such as the size and location of the tumor. You may also have a biopsy of your underarm lymph nodes at the same time to see if any cancer is there.
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The Same But Different
The story of progress in beating breast cancer is a testament to decades of painstaking work by researchers around the world. Nearly eight in 10 women diagnosed today will still be going strong ten years later, compared to around half that number back in the 1970s.
But this broadly positive picture of breast cancer hides a complex biological tapestry: not all breast cancers are equal.
For starters, around three quarters of all breast tumours are whats called ER positive, meaning they carry oestrogen receptors and so respond to the female sex hormone oestrogen. About two thirds of these are also PR positive, bearing receptors for another female hormone called progesterone. These types of cancers usually respond well to hormone-blocking treatments, such as tamoxifen, and there is a very good chance of surviving for a decade or more.
Then there are the HER2 positive bunch around one in five breast cancers. These carry multiple copies of a molecule called HER2, and tend to grow more aggressively. But they can be targeted by the drug Herceptin , which has helped to boost survival.
By a process of elimination, triple negative cancers are those that are left ER negative, PR negative and HER2 negative, and these make up roughly 15 per cent of all breast cancers somewhere in the region of 7,500 cases every year in the UK. Younger women under 40 are more likely to have this type, as are black women, and the cancers tend to grow and spread aggressively.
How Is Triple Negative Breast Cancer Different From Other Types Of Breast Cancer
Triple negative breast cancer is different from other types of breast cancer because it does not have any of the three receptors commonly found on breast cancer cells:
If you have triple negative breast cancer, you may notice that your treatment is slightly different from that offered to other people with breast cancer.
People with oestrogen and/or progesterone receptor positive breast cancer will usually take tamoxifen or an aromatase inhibitor as part of their treatment. People with HER2 positive breast cancer will usually take a drug called Herceptin. These drugs are not effective against triple negative breast cancer.
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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 or surgery 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.
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.
Sights Set On First Targeted Therapy For Triple
A new study is seeking new drugs to combat triple-negative breastcancer, an aggressive form of the disease that doesnt rely on thehormones estrogen and progesterone or the protein HER2, which fuel thegrowth of most breast cancers.
The projects goal? Find new drugs to combat the cancer, which doesnt rely on the hormones estrogen and progesterone or the protein HER2, which fuel the growth of most breast cancers.
Given this, the drugs that treat most breast cancers by blocking their ability to use those three things to survive dont work on triple-negative breast cancer, says Stacy Moulder, M.D., associate professor of Breast Medical Oncology and the trials principal investigator.
Instead, doctors are left to treat triple-negative patients with traditional chemotherapy drugs, surgery and radiation.
Typically, patients with a triple-negative breast tumor thats larger than one centimeter and hasnt spread to other parts of the body are given chemo before surgery. In nearly half of these patients, chemo works well. It kills all or nearly all of the cancer cells, and little to no cancer in the breast or lymph nodes is present at the time of surgery.
This is associated with an extremely good prognosis, Moulder says.
But the other half of patients who do not respond well to chemo face a high probability their cancer will come back within three years after treatment. When the disease returns, prognosis is poor.
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Early Stage Chemotherapy Combination Regimens
Due to the promising results in the metastatic setting of combination chemotherapy and ICIs, studies have now been conducted in early stages of TNBC. They have demonstrated preliminary success thus far. In the I-SPY 2 trial, patients with stage II/III disease treated with combination chemotherapy and pembrolizumab had estimated the pCR rate to be nearly three times that of those individuals with chemotherapy alone . The KEYNOTE-522 trial also demonstrated improved pCR rates and 18-month event-free survival when pembrolizumab was delivered in combination with chemotherapy in both the neoadjuvant and adjuvant settings . In contrast to the aforementioned findings, the NeoTRIPaPDl1 study demonstrated that standard chemotherapy in combination with atezolizumab did not significantly impact pCR rates in patients with early stage high-risk or locally advanced TNBC . High-risk disease was defined as disease with high proliferation or grade. The contrasting results of these two studies may be explained by chemotherapy backbones or due to differences in the ICI activity, given that PD-1 inhibitors but not PD-LA inhibitors block PD-L2 inhibitory signaling .
Targeted Drug Therapy For Breast Cancer
Targeted drug therapy uses medicines that are directed at proteins on breast cancer cells that help them grow, spread, and live longer. Targeted drugs work to destroy cancer cells or slow down their growth. They have side effects different from chemotherapy and can be given in the vein , as an injection under the skin, or as a pill.
Some targeted therapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered immunotherapy because they boost the immune system.
Like chemotherapy, these drugs enter the bloodstream and reach almost all areas of the body, which makes them useful against cancers that have spread to distant parts of the body. Targeted drugs sometimes work even when chemo drugs do not. Some targeted drugs can help other types of treatment work better.
Several types of targeted therapy drugs can be used to treat breast cancer.
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What Is The Prognosis For Triple
A good treatment result depends on several factors. Chemotherapy is what can really make a difference in the outcome. The size of the invasive part of the tumor, and the number of involved lymph nodes can also greatly influence your prognosis, Sun says, but adds that if the cancer has spread , the prognosis is less certain.
There is hope, even with this serious diagnosis, and staying optimistic is essential. It can be stressful and scary to go through chemo, but positive thinking can make a difference. You have to believe that its doing you good, and for most people, it does.
Breast Cancer Treatment at Johns Hopkins
The breast cancer program at Johns Hopkins is made up of a diverse group of nationally-recognized specialists in breast cancer research and treatment.
Monoclonal Antibodies Targeting Immune Checkpoints In Metastatic Setting
Immune checkpoints are molecules that protect against normal tissue damage caused by over-activity of T-cells . PD-1 and its ligand PD-L1, the most widely studied immune checkpoint receptors in the treatment of breast cancer, are expressed on activated T-cells, B-lymphocytes, and natural killer cells and are associated with tumor immune resistance . An abundancy of genes involved in immune cell processes and high levels of tumor-infiltrating lymphocytes implying high immunogenicity for the IM subtype of TNBC . These characteristics suggest that immune checkpoint inhibitors are feasible therapeutic agents for TNBC. ICIs were first investigated amongst metastatic TNBC patients as a monotherapy. Subsequently, there have been trials to investigate ICIs in combination with chemotherapy agents to enhance response rates, as well as using ICIs in the neoadjuvant setting.
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Fda Approves New Therapy For Triple Negative Breast Cancer That Has Spread Not Responded To Other Treatments
- For Immediate Release:
Today, the U.S. Food and Drug Administration granted accelerated approval to Trodelvy for the treatment of adult patients with triple-negative breast cancer that has spread to other parts of the body. Patients must have received at least two prior therapies before taking Trodelvy.
Metastatic triple-negative breast cancer is an aggressive form of breast cancer with limited treatment options. Chemotherapy has been the mainstay of treatment for triple-negative breast cancer. The approval of Trodelvy today represents a new targeted therapy for patients living with this aggressive malignancy, said Richard Pazdur, M.D., director of the FDAs Oncology Center of Excellence and acting director of the Office of Oncologic Diseases in the FDAs Center for Drug Evaluation and Research. There is intense interest in finding new medications to help treat metastatic triple-negative breast cancer. Todays approval provides patients whove already tried two prior therapies with a new option.
The most common side effects for patients taking Trodelvy were nausea, neutropenia, diarrhea, fatigue, anemia, vomiting, alopecia , constipation, decreased appetite, rash and abdominal pain.
The FDA granted approval of Trodelvy to Immunomedics, Inc.
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What To Drink And Eat
Matcha Tea: Every morning is just better when it starts with tea, or really any time of day for that matter! Once you know that this type of tea contains epigallocatechin-3-gallate , which can kill cancer cells by limiting angiogenesis, prevent DNA damage, and may stop the production of breast cancer stem cellsit is even more of a treat! Matcha tea provides up to 137 times more EGCG than regular green tea! So drink upI suggest 2 cups a day of this type of Matcha Tea. It is also packed with antioxidants, vitamin C, tocopherols, carotenoids, selenium, zinc, chromium, and manganese. Matcha also detoxifies heavy metals and toxic chemicals while burning fat and boosting your metabolism.
Drinking tea is also a great life metaphor. We are like teawe dont know our strength until we are in hot water -says many revolutionary women. Right now, you are realizing just how strong you are and then finding even more power, my dear conqueror. Buy Matcha Tea.
Blueberries: A berry delicious way to increase the number of cancer destroying Natural Killer cells in the body and slow or stop the growth of Breast Cancer Stem Cells is to enjoy a handful of organic blueberries every day. This study found that these berries can cause apoptosis in TNBC cells! You can also order a blueberry concentrate from Life Extension if you are trying to keep your sugars down. Here is my full report on these little superheroes, and I highly suggest this delectable Blueberry Chia Pudding!
Different Drugs Same Target
Breast cancers that are HER2-positive tend to be aggressive, with the excess HER2 protein on tumor cells fueling the cancers growth. In the late 1990s, trastuzumab was among the first targeted cancer therapies to be approved by FDA, after trials showed it could improve survival in women with metastatic HER2-positive breast cancer.
Over time, other HER2-targeted therapies emerged, some with alternative mechanisms for disrupting HER2 activity in cancer cells. Drugs like trastuzumab and pertuzumab are monoclonal antibodies that bind to the HER2 protein above the cancer cells surface, preventing it from acting or enlisting the immune system to help destroy cells that produce it.
Tucatinib, on the other hand, is a member of a class of drugs known as tyrosine kinase inhibitors . These drugs work by binding to the part of the HER2 protein that is inside the cell and preventing it from sending signals that promote cell growth. Other HER2-targeted TKIs include neratinib and lapatinib .
Some TKIs have multiple targets. But, compared with other HER2-targeted drugs, tucatinib appears to be relatively selective for HER2that is, its less likely to bind to related proteins, explained Stanley Lipkowitz, M.D., Ph.D., chief of the Womens Malignancies Branch in NCIs Center for Cancer Research. That selectivity limits the risk of side effects seen with other HER2-targeted TKIs that inhibit other targets, Dr. Lipkowitz said.
New Therapies For Triple
According to experts, triple-negative can be a very treatable and potentially curable type of breast cancer, especially with recent research advances. Treatment of triple-negative breast cancer involves both local therapies, such as surgery and radiation, and can also include systemic therapies, like chemotherapy. Thanks to research in recent years, another category of medications is available, known as immunotherapy, where medicines help stimulate the immune system to destroy cancer cells. This category of medication is used with chemotherapy and is used depending on factors, such as the stage of the cancer.
New discoveries, such as immunotherapy, are starting to change the previous beliefs that triple-negative breast cancer is untreatable, experts say.
The introduction of immunotherapy into the treatment of triple-negative breast cancer may be a game changer.
âWe are incredibly gratified to see that offering immunotherapy before surgery not only helps to do a better job killing the cancer cells, but also seems to help prevent the cancer from coming back, which may help people live longer,â said Mayer. âSo the introduction of immunotherapy into the treatment of triple-negative breast cancer may be a game changer.â
âItâs also important to be aware of oneâs body and notice any changes, pointing them out to oneâs doctor if they arise,â Mayer said.
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