Treatment Options In The Earlier Stages
Early-stage breast cancer is generally considered to be stages 0 through 3, Bora Lim, M.D., assistant professor in the Breast Medical Oncology department at the University of Texas MD Anderson Cancer Center, tells SELF.
Because there are no approved targeted therapies available in the earlier stages of triple negative breast cancer, the standard of care is chemotherapy, according to the NCI. This is a systemic therapy, meaning it affects cells throughout your body, says Dr. Nanda, who specializes in the treatment of triple negative breast cancer along with early-onset, hereditary, and locally advanced breast cancers. It involves taking drugs orally, via injection, through infusion, or even topically. These drugs then travel throughout the bloodstream and destroy or halt the division of cancer cells. The chemo that we use is the same regimen as for any type of breast cancer, Dr. Nanda says.
Typically, you will receive chemo in combination with surgery . Sometimes chemo comes after surgery, but your doctor might suggest doing it before, Wendy Y. Chen, M.D., M.P.H., breast oncologist at the Dana-Farber Cancer Institute and assistant professor of medicine, at Harvard Medical School, tells SELF. This helps shrink the tumor as much as possible before removing it, which has an added benefit: The more knowledge about the treatment responsiveness of the tumor that someone has, the more we know about their prognosis, Dr. Chen explains.
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.
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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Brca1 Inherited Gene Mutations And Tnbc
Most breast cancers related to a BRCA1 inherited gene mutation are both triple negative and basal-like .
TNBC may also be related to a BRCA2 inherited gene mutation .
The National Comprehensive Cancer Network recommends people diagnosed with TNBC at age 60 or younger get genetic testing .
Learn more about genetic testing.
Why Treating Triple Negative Breast Cancer Is Difficult
You may remember all of this information were about to share from your conversations with your doctors, but if not, heres a quick reminder of what makes triple negative breast cancer different from other breast cancers.
Theres basically no end to the different ways to categorize breast cancer. One important method for classifying this disease is based on the types of receptors or proteins the cancer cells might have, which can affect how the cancer grows in your body, the American Cancer Society explains.
Heres how the Centers for Disease Control and Prevention illustrates it: Cancer cells are like a house with receptors as different locks on the front door. If your cancer cells have any of these locks, your doctor can use certain keys called targeted therapies to help unlock the doors to the cancer cells and destroy them.
Breast cancer cells can have three kinds of receptors : One receptor is for the hormone estrogen, another is for the hormone progesterone, and the last is for an overgrowth of the protein human epidermal growth factor receptor 2 . Without any of these receptors, targeted treatments wont work, which is why triple negative breast cancer is generally thought of as the most difficult subtype to treat, the National Cancer Institute explains.
But that doesnt mean triple negative breast cancer is impossible to treat. Doctors have their ways, and many consider the future of treating this illness to be bright.
Can Tnbc Be Prevented
Researchers dont know all the factors that cause triple negative breast cancer. They have identified the BRAC1 gene mutation as one potential cause for triple negative breast cancer. Unfortunately, you cant prevent BRAC1 because you inherit this gene mutation from your parents.
But there are steps that help prevent breast cancers, including TNBC:
- Maintain a healthy weight.
- Exercise on a regular basis.
- Know your family medical history.
- Monitor your breast health. Studies show 95% of women whose breast cancer was treated before it could spread were alive four years after diagnosis.
- Talk to your healthcare provider about genetic testing for the BRCA gene if you have a family history of breast cancer, ovarian cancer, pancreatic or prostate cancer. If you have the BRCA gene, there are steps you can take to prevent breast cancer.
A New Treatment Option
Atezolizumab in combination with the chemotherapy drug nab-paclitaxel will be a new option for adults with triple negative breast cancer thats spread to other parts of the body, where surgery has been ruled out as an option.
It will only be an option for patients whose tumours test positive for a molecule called PD-L1 and who have not had chemotherapy once their cancer has spread.
Atezolizumab is a type of immunotherapy called a checkpoint inhibitor that works by preventing PD-L1 from interacting with immune cells, boosting the immune cells chances of killing tumour cells.
Around 2000 people have triple negative breast cancer in England, of whom roughly 600 people would be suitable for the immunotherapy treatment. This type of breast cancer often affects younger patients and can be more aggressive than other types of breast cancer.
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Progress In Treating Her2
HER2-positive and triple-negative breast cancer are among the most aggressive forms of breast cancer and traditionally have had lower survival rates than other types of the disease. However, early detection with routine screening has contributed to improved survival for both in recent years. Further, treatment advancesall available at Regional Cancer Care Associates , one of the nations largest networks of cancer specialists with locations in New Jersey, Maryland, and Connecticutalso have helped improve outcomes in HER2-positive cancer. Meanwhile, intensive research and emerging therapeutic strategies are offering new hope for women with triple-negative breast cancer.
Four RCCA medical oncologists recently explained what drives the development of these breast cancers, how they are treated, and how women can play an important and potentially life-saving role in identifying the cancers in their earliest stages, when they can be treated most effectively.
Aileen Chen, MD, a board-certified medical oncologist practicing with RCCA in Freehold and Holmdel, NJ says, Its an exciting time in the fight against breast cancer. Next-generation sequencing technology is detecting genetic mutations that we can treat with targeted therapies in many forms of the disease. This has enhanced our ability to practice personalized medicine by customizing a patients treatment based on her molecular and genetic profiles.
Treatment Modalities Of Tnbc
Patients with TNBC do not benefit from hormonal or trastuzumab-based therapy because of the loss of target receptors such as ER, PGR, and HER-2. Hence, surgery and chemotherapy, individually or in combination, appear to be the only available modalities. However, some studies have identified certain receptors as targets for new therapeutic drugs.
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Treatment Of Advanced Disease
In patients with advanced TNBC treated with an anthracycline with or without a taxane in the neoadjuvant or adjuvant setting, carboplatin demonstrated comparable efficacy and a more favorable toxicity profile than docetaxel.19 In the subgroup of patients with germline BRCA1/2-mutated breast cancer, carboplatin showed to double the objective response rate as compared to docetaxel .19 This suggests the importance of characterizing the BRCA1/2 mutation status of patients with advanced disease to also help informing on the choices of the best first-line chemotherapy approach.
Poly ADP-ribose polymerase inhibitors
In metastatic patients harboring a germline BRCA mutation, olaparib has shown important activity in both TNBC and luminal-like disease.2022 The OlympiAD study was designed to compare the use of olaparib versus standard single-agent chemotherapy in BRCA-mutated breast cancer patients. Among the 302 patients that underwent randomization, 205 received olaparib and 97 received standard chemotherapy. Response rate was 59.9% in patients receiving olaparib and 28.8% in patients receiving standard chemotherapy. The rate of adverse events was higher in the chemotherapy group versus the olaparib group . Median progression-free survival was 7.0 months with olaparib and 4.2 months with chemotherapy . However, no significant difference was observed in OS that was 19.3 months with olaparib and 17.1 months with standard therapy .23,24
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.
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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.
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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Her2 Breast Cancer Treatment
Targeted therapy is the hallmark of treatment for HER2-positive cancer. The drug used most often is trastuzumab . Trastuzumab interferes with HER2 production and slows or prevents the cancer cells from growing. It is often administered with the chemotherapy agent emtansine in a combined drug called T-DM1.
Another medication, pertuzumab , is sometimes prescribed with trastuzumab when the cancer has spread to other parts of the body or metastasized. Oncologists also may prescribe an aromatase inhibitor, such as lapatinib or neratinib to lower estrogen levels.
If the cancer is also HR-positive, oncologists often prescribe endocrine therapy after the completion of targeted therapy. Endocrine or hormone therapy helps prevent cancer from returning by suppressing estrogen production. Tamoxifen is a common form of endocrine therapy used primarily in premenopausal women. It belongs to a class of drugs called selective estrogen receptor modulators .
Postmenopausal women have the option instead of taking an aromatase inhibitor , such as anastrozole , exemestane , or letrozole to block estrogen production. Postmenopausal women who have completed a tamoxifen regimen may be encouraged to follow up with an AI for added benefit.
Parp Inhibitors Beyond Olaparib/talazoparib And The Metastatic Setting
Several other PARP inhibitors beyond olaparib and talazoparib are currently under investigation for the treatment of patients with BRCA-mutated breast cancer.31 Veliparib has been investigated in breast cancer patients with metastatic disease in combination with chemotherapy. A significant anti-tumor effect was shown with the combination of veliparib plus temozolomide.32 In the BrighTNess phase III randomized trial, the addition of veliparib to carboplatin and standard neoadjuvant chemotherapy did not show any advantage related to pathologic complete response compared to carboplatin and standard chemotherapy.33
To investigate the activity of PARP inhibitors in TNBC patients, both in the adjuvant and the post-neoadjuvant settings, the phase III OLYMPIA trial is currently randomizing early HER2-negative breast cancer patients harboring BRCA germline mutations to 1 year of olaparib or placebo after surgery and standard chemotherapy.15
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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.
“We 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,” said Mayer. “So the introduction of immunotherapy into the treatment of triple-negative breast cancer may be a game changer.”
“It’s also important to be aware of one’s body and notice any changes, pointing them out to one’s doctor if they arise,” Mayer said.
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
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What Tests And Exams Diagnose Triple
The diagnosis of triple-negative breast cancer requires a sampling of tissue from the breast, known as a breast biopsy. Medical professionals may perform the biopsy using imaging techniques, such as mammography or others, for guidance. If the biopsy shows cancer, they may perform other tests on the biopsy sample to determine the precise type of cancer. In particular, they commonly perform tests for expression of the estrogen receptor , progesterone receptor , and HER2 protein as a first step. If these tests are all negative, they classify the cancer as triple-negative breast cancer.
What Is The Staging Of Triple
Staging is the process of determining the extent of the cancer and its spread in the body. Together with the type of cancer, staging helps determine the appropriate therapy and predict the chances for survival.
To determine if the cancer has spread, medical professionals may use several different imaging techniques, including X-ray, CT scans, bone scans, and PET scans. Staging depends upon the size of a tumor and the extent to which it spread to lymph nodes or distant sites and organs in the body. Examination of lymph nodes removed at surgery and the results of ER, PR, and HER2 tests performed on the tumor tissue also help determine the stage of a tumor. Stage I is the lowest stage, while stage IV is the highest stage and refers to tumors that have metastasized, or spread to areas distant from the breast.
Most doctors specifically adjust breast cancer treatments to the type of cancer and the staging group.
Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer consist of breast-conserving surgery and mastectomy .
Types of chemotherapy include the following:
Other therapies for triple-negative breast cancer