Is Triple Negative Breast Cancer An Aggressive Form Of Cancer
Its true that triple negative breast cancers can grow quickly. But your prognosis or expected outcome depends on more factors than your cancer subtype. Healthcare providers will also consider your tumors size and whether it has spread to your lymph nodes and other parts of your breast. Its also helpful to know researchers are focusing on ways to slow the spread of TNBC.
Treatment For Triple Negative Breast Cancer
The main treatments for triple negative breast cancer are surgery, chemotherapy and radiotherapy. The treatment you need depends on:
- where the cancer is
- the size of the cancer and whether it has spread
- how abnormal the cells look under the microscope
- your general health
You might have surgery to remove:
- an area of the breast
- the whole breast
When you have your surgery, the surgeon usually takes out some of the lymph nodes under your arm. They test these nodes to see if they contain cancer cells. The surgeon might check the lymph nodes closest to the breast using a procedure called sentinel lymph node biopsy. Testing the lymph nodes helps to find the stage of the cancer and decide on further treatment.
After breast conserving surgery you usually have radiotherapy to the rest of the breast tissue.
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.
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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.
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
How Serious Is Stage 2 Of Cancer
Stage II of lung cancer is still considered an early stage, yet some stage II cancers include metastases to nearby lymph nodes. Today, the standard of care for this stage consists of surgery followed by chemotherapy. Deaths from lung cancer are the most common among all cancer-caused deaths in the United States. Often, it is a serious illness with the potential to progress quickly.
What is Stage 2 cancer mean?
Stage II cancer . Stage II cancer refers to larger tumors or cancers that have grown more deeply into nearby tissue. In this stage, the cancer may have spread to the lymph nodes, but not to other parts of the body.
Only 40 percent of those who get the disease survive for three years. The survival rate for triple-negative breast cancer patients as a whole is 70 percent. Triple-negative cancers test negative for estrogen receptors, progesterone receptors, and HER2.
How to survive triple negative breast cancer?
Radiation is another potential treatment for people with triple negative breast cancer . Radiation targets and kills the cancer cells to stop their growth and spread. Studies suggest that chemotherapy may be the best treatment option for triple negative breast cancer .
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Survival Rates For Triple
The five-year survival rate for someone with localized triple-negative breast cancer, cancer that has not spread beyond the breast, is 91 percent . For cancer that has spread into nearby lymph nodes or nearby areas, the five-year survival rate is 65 percent. For cancer that has spread further into the body, such as into the bones, lungs or liver, survival is 11 percent.
Survival rates are averages determined by whats happened in the past. As research and cancer treatment evolve, the outlook may improve.
These statistics are recorded in the SEER database, which is maintained by the NCI, and do not differentiate between stages of cancer or take into account variables such as patient age and overall health.
Expert cancer care
Immunosuppressive Immune Cells In The Tnbc Tumor Microenvironment
The tumor microenvironment involves the surrounding blood vessels, fibroblasts, immune cells, signaling molecules and the extracellular matrix around the tumor . Tumor Infiltrating Lymphocytes produce endogenous antitumor immune response for inhibiting tumor progression and improving free survival rate of TNBC patients . Tumor associated macrophages are important for immunosuppressive role by secreting inhibitory cytokines, regulatory T cells infiltration promotion, and reactive oxygen species reduction . Cancer-Associated Fibroblasts lower anti-tumor immunity, favor tumor cell proliferation and invasion and reshape the extracellular matrix . Tumor associated neutrophils aid in lysing tumor cells and induce antitumor function .
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What About Breast Cancer In Men
The stages of breast cancer relate to how much the cancer has grown and how far its spread. Generally, the earlier breast cancer is diagnosed and treated, the higher the chances for long-term survival.
|Stage 0||This is a precancerous stage with no invasive cancer cells.|
|Stage 1||The tumor is small and localized to the breast. There may be a small amount of cancer in nearby lymph nodes.|
|Stage 2||The tumor is still localized to the breast but is larger and may have spread to several nearby lymph nodes.|
|Stage 3||This stage includes cancers that have spread to the skin, chest wall, or multiple lymph nodes in or near the breast.|
|Stage 4||This is metastatic breast cancer, meaning its spread to one or more distant parts of the body, most commonly to the bones, lungs, or liver.|
The stages of breast cancer are based on the following factors:
- whether the lymph nodes contain cancer cells
- whether the cancer has metastasized, meaning its spread to other, more distant parts of the body
Since 2018, the following factors have also been used to determine breast cancer stage:
- whether the cancer cells have hormone receptors and need estrogen or progesterone to grow
- whether the cancer cells have the HER2 protein that helps them grow
- tumor grade, meaning how aggressive the cells look under the microscope
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.
Triple Negative Breast Cancer Survival Statistics
Triple Negative Breast Cancer or TNBC is a diagnosis of a type of breast cancer that does not have one of the three most common identifiers. It means that it is negative for the three most common receptors that are typically identified during the testing process to determine which type of treatment is best to fight the cancer. A diagnosis of TNBC means that HER 2 gene is not present, estrogen and progesterone receptors are also not present in the tumor. While it sounds quite awful because of the triple negative factor and it can be a little different to treat it can actually be more responsive in the early stages to chemotherapy than other types of cancers.
Existing And Investigational Treatment Paradigm
From a chemotherapeutic perspective, TNBC is very sensitive, and treatments require extreme care. Common treatment involves the use of alkylating agents , anthracycline , anti-metabolite fluorouracil, and anti-microtubule agent . For early diagnosis of TNBC, neoadjuvant chemotherapy and subsequent surgery are applied. No standard chemotherapy has been described for the treatment of relapsed TNBC. Treating advanced TNBC includes the following drugs: gemcitabine and capecitabine , eribulin , and platinum . The conventional treatment options for TNBC are listed in Table 1.
TABLE 1. Conventional treatment option for TNBC.
TABLE 2. Different types of nano medicines under experimental and clinical testing for TNBC theranostics .
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Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor, who is familiar with your situation, about how these numbers may apply to you.
What Does Triple Negative Mean In Terms Of Breast Cancer
Normal breast cells have receptors that respond to hormones such as estrogen and progesterone, which allows them to grow and regress in response to the hormone level. Hormone receptors may or may not be present in breast cancer. About two-thirds of breast cancers are positive and contain these receptors like normal breast cells do. These are less aggressive cancers that are less likely to need chemo and are often treated with hormone therapy and surgery. Radiation may or may not be needed.
HER2/neu , is a protein molecule that has a role in cell proliferation in normal cells. In some breast cancers, this protein is overly produced or positive. For HER2-positive tumors, there a specific medication that targets this protein.
Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. Since these targets are absent in triple-negative breast cancer, chemotherapy is needed, Sun says. Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also. But there are several ways we can address it.
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How Is Triple Negative Breast Cancer Diagnosed
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.
Sometimes providers use the following tests before treatment to check on your tumors size and whether it has spread, or after treatment to monitor response to treatment:
Triple Negative Breast Cancer Clinical Trial
Ongoing clinical trial tried to investigate effectiveness and safety of different possible treatment for future use and also has several clinical trials in the pipeline. The patient can also enroll their name in these trials to get novel therapies and also assist in research by providing the data to the research team. The different research aim is different, some are investigating new therapies to treat the patient, whereas some drugs may use in preventive therapy. Name registration for a clinical trial is the first step to enrolling name to the research3,4.
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Survival Rates And Prognosis
The outlook for breast cancer is often described in terms of relative survival rates.
Relative survival rates are an estimate of the percentage of people who will survive their cancer for a given period of time after diagnosis. Survival among people with cancer is compared to survival among people of the same age and race who have not been diagnosed with cancer.
Five-year relative survival rates tend to be lower for triple-negative breast cancer than for other forms of breast cancer.
According to the American Cancer Society, the overall 5-year relative survival rate for TNBC is . However, an individuals outlook depends on many factors, including the stage of the cancer and the grade of the tumor.
Your healthcare professional will be able to give you a more precise outlook based on:
- the stage of your TNBC
Our Breast Cancer Specialists
The breast cancer specialist team at Siteman comprises outstanding Washington University medical oncologists, radiation oncologists, surgeons, radiologists, geneticists and psychologists. The diverse expertise of our specialists is what allows them to create individualized treatment plans for all triple-negative breast cancer patients.
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Sample Type And Sample Size Required
The minimum sample size required was calculated before data collection for the primary objective with the following assumptions: statistical significance level p< 0.05, targeted statistical power of 80%, eight prognostic factors , and minimum partial coefficient of determination considered clinically relevant R20.10. Under these assumptions, a sample size of 144 patients was finally required. Given the retrospective nature of the study, we expected that 15% of patients would have missing data on the primary outcome and at least one of the eight prognostic factors. Therefore, we decided to increase the number of enrolled patients to 170.
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.
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.