Breast cancer that tests negative for estrogen receptors, progesterone receptors, and high HER2 protein is known as triple-negative breast cancer. These findings indicate that the hormones estrogen and progesterone, as well as the HER2 protein, are not fueling the cancer's development. As a result, hormone treatment or drugs that target the HER2 protein receptors have no effect on triple-negative breast cancer. 10-20 % of all breast cancers are triple-negative. Finding new medicines to treat this kind of breast cancer is a top priority for doctors and researchers. Certain medicines are being studied to see whether they can interfere with the mechanisms that cause triple-negative breast cancer to develop.
Common features of triple negative breast cancer
- Because there are fewer specific medications available to treat triple-negative breast cancer, it is thought to be more aggressive and have a worse prognosis than other forms of breast cancer. Triple-negative breast cancer has been found in studies to be more likely to spread outside the breast and to return following therapy.
- It has a greater prognosis than other forms of breast cancer. In terms of appearance and development patterns, the higher the grade, the less cancer cells resemble normal, healthy breast cells. Triple-negative breast cancer is frequently grade 3 on a scale of 1 to 3.
- It's generally a sort of cell known as "basal-like." The term "basal-like" refers to the cells that border the breast ducts and are similar to basal cells. Basal-like tumours, such triple-negative breast cancers, are more aggressive and have a higher grade.
Incidence
Triple-negative breast cancer may affect anyone at any time. Nonetheless, studies have discovered that it is more prevalent among:
- Younger persons: People under the age of 50 are more likely to be diagnosed with triple-negative breast cancer. People over the age of 60 are more likely to be diagnosed with other forms of breast cancer.
- Black and Hispanic women: Black and Hispanic women are more likely to be diagnosed with triple-negative breast cancer. Asian women and non-Hispanic white women have a lower risk of developing this disease.
- People who have the BRCA1 gene mutation: In patients who have an inherited BRCA mutation, particularly BRCA1, around 70% of breast tumours are triple-negative.
Treatment of triple negative breast cancer
Surgery, radiation, and chemotherapy are generally used to treat triple-negative breast cancer. Hormone therapy and medicines that target HER2 are ineffective because cancer cells lack oestrogen and progesterone, thus chemotherapy (chemo) is the major systemic therapeutic option.
Chemotherapy: A cancer-killing drug will most likely be the first thing your doctor tries. It can be injected into a vein or taken as a tablet. This kind of cancer may react better to treatment than others if found early. Chemotherapy can be administered in one of three ways by a doctor:
Neoadjuvant treatment is when you receive chemotherapy before surgery in order to reduce the tumour and make the procedure simpler. If you have locally advanced breast cancer and your doctor doesn't think they can operate immediately now, or if your cancer makes it unlikely that your breast can be saved, this is the best option.
Adjuvant treatment is performed after surgery. If you have a big tumour or if your lymph nodes are affected, you could develop triple negative breast cancer, and you're more likely to relapse. Hormone therapies and other forms of adjuvant therapy won't work with triple-negative breast cancer.
When cancer has spread and surgery is not an option, immunotherapy is combined with chemotherapy.
Surgery: There are two types of surgery. Because triple-negative breast cancer is aggressive, many doctors believe that removing the entire breast with a mastectomy is the best option. Another alternative is to have a lumpectomy, which removes only the tumour and the surrounding tissues.
Radiation: After surgery, radiation is frequently used to eliminate any cancer cells that remain. The objective is to prevent the cancer from returning. It is typically done after a lumpectomy.
Treatment through different stages
Stages I-III triple-negative breast cancer
Breast-conserving surgery or a mastectomy with a lymph node check may be performed if the early-stage TNBC tumour is small enough to be eliminated by surgery. Radiation may be used after surgery in some circumstances, such as when a big tumour or cancerous lymph nodes are discovered.
Chemotherapy is the major systemic treatment for women with TNBC because hormone therapy and HER2 medicines are not effective. It can be administered alone or in combination with pembrolizumab to reduce a big tumour before surgery (neoadjuvant chemotherapy). After surgery, you may be given chemo or pembrolizumab (adjuvant therapy) to minimise the risks of the cancer returning.
Stage IV triple-negative breast cancer
When cancer has progressed to other regions of the body, chemo is frequently administered initially (stage IV). Anthracyclines, taxanes, capecitabine, gemcitabine, eribulin, and other chemotherapy medicines are commonly used. Other chemo drugs called platinum drugs (like cisplatin or carboplatin) or targeted drugs called PARP inhibitors, such as olaparib (Lynparza) or talazoparib (Talzenna), may be considered for women with TNBC who have a BRCA mutation and whose cancer no longer responds to common breast cancer chemo drugs.
Immunotherapy combined with chemotherapy might be the first line of treatment for advanced TNBC with the PD-L1 protein in cancer cells (either atezolizumab along with albumin-bound paclitaxel, or pembrolizumab and chemotherapy). One out of every five TNBCs has the PD-L1 protein.
Recurrent triple-negative breast cancer
If TNBC returns (recurs) locally, is unable to be eliminated surgically, and produces the PD-L1 protein, immunotherapy using the medication pembrolizumab in combination with chemotherapy is a possibility. Depending on the scenario, other therapies may be available. If the cancer spreads to other regions of the body, chemotherapy or the antibody-drug combination sacituzumab govitecan may be used.
Clinical Trials
With so much study into new treatments, it's a good idea to check with your doctor to see whether this is something that might be beneficial to you. Clinical trials assist scientists in determining the safety and efficacy of new medicines. It's frequently an excellent method to obtain a new drug that isn't widely available.
Participating in a clinical trial of new treatments for TNBC, regardless of the stage of the cancer, is a good option because TNBC is uncommon and has a poor prognosis (outcome) compared to other types of breast cancer, and because these studies often provide patients with access to drugs not available for standard treatment.
Although triple-negative breast cancer is more likely than other types to spread to other parts of the body, the chance of this happening decreases over time. After 3 years of therapy, the risk rises and then rapidly declines. Triple-negative breast cancer is a form of aggressive breast cancer that does not respond to treatments that are effective against other types of breast cancer. A doctor may be able to cure it with intensive therapy if it is detected early. There is no known cure when a doctor detects it after it has spread, but certain therapies can help a person live longer with a higher quality of life. People with triple-negative breast cancer should seek out a doctor who is up to speed on the newest therapies and can assist them in locating new clinical trials that may be of assistance.
Don't forget to inform your friends and family about what's going on, and to seek for support if you need it. It's up to you who you tell and when you tell them, but the more you tell them, the more equipped they'll be to help you when you need it.
Sources:
https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-triple-negative.html
https://www.medicalnewstoday.com/articles/new-triple-negative-breast-cancer-treatments#takeaway