About 20% of people with breast cancer have a type called Triple-negative breast cancer (TNBC).
It generally has a poorer outlook than other breast cancers. also tends to influence non hispanic black women And women under 40 more often. But it can be difficult to treat because some common cancer treatments, such as anti-hormones and anti-HER2, don’t work with TNBC.
in WebMD Webinars “Triple-Negative Breast Cancer: How We’re Learning to Treat It More Effectively,” Kevin Kalinski, MD, explained how TNBC is different and how new treatments are offering hope.
Most people with TNBC were interested in either empowering themselves with information about their cancer type or choosing a treatment plan.
More than half of respondents said that spending quality time with family and friends as part of a cancer treatment plan is the type of self-care that interests them most.
“Do older people get triple-negative breast cancer? Is treatment different for them than for younger women who get it?”
“How does TNBC affect childbearing potential? What about its effect on breastfeeding?”
We can also see triple-negative breast cancer in older people. It is important for us to define what we mean by “old”. For example, age over 70 years.
In general, the most common subtype of breast cancer is hormone receptor-positive, HER2-negative breast cancer. I think the prevalence of having this form is even higher if you are over the age of 70. However, we also see people with TNBC in that subgroup.
As we get older, we may also develop other health problems. Treatment depends on the health of the person. We create an individual treatment plan for each person. If we have a very healthy person who is older, we often take a similar approach to a younger person.
For its effect on having children: Along with chemotherapy during early-stage breast cancer, you can take a drug that tells your brain to stop your ovaries from making estrogen. It is safe to do so, and we know it can preserve fertility. For premenopausal people, it’s always something that we bring up. Often, we also refer a person to a fertility doctor.
We want a person with TNBC to have a window from surgery to trying to get pregnant. He is almost 2 years old.
For people with TNBC who have metastatic disease, meaning it has spread to other parts of the body, we do not suggest they become pregnant. This is because we provide therapies that are not safe during pregnancy.
In terms of breastfeeding, it depends on what’s happening at the time. We generally do not recommend breastfeeding if you are actively receiving chemotherapy.
Immunotherapy is new. We don’t yet know the effect on fertility, but experts continue to study it.
“What do you recommend for addressing this Mental health effects of having TNBC,
What are the top self-care tips you recommend for someone with TNBC? Do they make a difference in forecasting?”
“What are the most important precautions for preventing it from coming back in the first 5 years after TNBC diagnosis and treatment?”
In our clinic it is normal to ask how people are doing. Some centers have a greater availability of therapists or psychiatrists than others. Some places also have social workers and spiritual health experts.
Don’t underestimate it. If you are struggling it is important to let your provider know.
In terms of self-care, information is power. It is important to visit well-established sites that provide accurate information. It’s also important to find a provider with whom you feel comfortable – someone you trust and someone who communicates in a helpful way.
Especially on that first visit, bring a loved one, friend or family member with you as you may be very anxious. It can be important to have someone with you to listen and collect information. Also, consider some non-Western medical alternatives. Experts can guide you as to complement some of these treatments that you may receive.
Be kind to yourself, especially in the beginning when things can be very stressful.
As for precautions, for people with stage I to III TNBC (meaning it hasn’t spread beyond your breasts or nearby lymph nodes), the risk of recurrence is higher in the first 5 years. After those first 2 years we take a deep breath. Then, by the end of 5 years, if there is no recurrence, we can exhale completely.
This is different from patients who have had estrogen-driven breast cancer, where we may see late recurrences after 5 years.
My general rule of thumb is: If you have any new symptoms not otherwise explained that last for 2 weeks or longer, let your doctor know.
“Is there any benefit in taking immunotherapy after 2 years of treatment when the cancer is undetectable?”
“How does someone get into a clinical trial for triple-negative breast cancer? Are they a good idea to participate in?”
standard is to take 1 year immunotherapy For patients who have stage II to III TNBC.
They start immunotherapy with chemotherapy before going into surgery. Regardless of what we see at the time of surgery, they continue immunotherapy for a full year, including the time before surgery.
But we haven’t done a 1 versus 2 year evaluation. For people who have nothing in their breast or lymph nodes at the time of surgery, it is standard to continue immunotherapy. But we don’t know if this is necessary. There is a larger study that will look into this to make sure we are not over-treating people.
For clinical trials, I cannot stress enough how important it is to do them. Whatever progress we have today is purely due to clinical trials. There is a website to find these, clinicaltrials.gov. You can type in information such as “triple negative” to help find one for you. The site will also find people who are close to you.
This means that your breast cancer does not have these three receptors:
“Estrogen and progesterone are hormones that we all make, and those receptors are the doors that let the hormones in and feed the cancer cell,” Kalinsky said. HER2 is a gene that helps breast cancer cells grow.
There are pills that target estrogen and intravenous (IV) and subcutaneous (under the skin) treatments that target HER2. But these do not work for TNBC. “Without those receptors, treatments that block estrogen or HER2 are not effective,” Kalinski said.
Some drugs were recently approved to treat people with early-stage and metastatic TNBC. they include:
Immunotherapy. This intravenous (IV) treatment (meaning it goes into your vein) tells your body to attack the cancer. It is approved for many forms of cancer.
Pembrolizumab (Keytruda) is now approved for people with metastatic TNBC whose tumors express a protein on the cancer cell called PD-L1.
For stage II to III TNBC (meaning if you have one positive lymph node under your arm or your cancer is more than 2 centimeters), doctors often give immunotherapy and chemotherapy before surgery.
PARP blocker. These are approved if you have metastatic breast cancer. They are oral medications (medicines you take by mouth) and targeted therapies that block an enzyme called PARP. It helps prevent cancer that has a BRCA mutation, by repairing its DNA and staying alive. These treatments are approved for people with a BRCA mutation.
If you have HER2-negative breast cancer (which includes TNBC) and a BRCA mutation, you may take olaparib (Linparza) for one year. Your doctor may also prescribe talazoparib (Talzen).
“In one study, we clearly saw that cancer growth was delayed if people received a PARP inhibitor compared to chemotherapy,” Kalinski said.
Antibody drug conjugate. It is a combination of chemotherapy and monoclonal antibodies. The antibodies attach to proteins on breast cancer cells and deliver chemotherapy directly to the cancer.
“You can think of it like a GPS drug,” Kalinski said.
“The antibody targets this protein and then delivers the chemotherapy directly to the cancer cell, rather than through a vein.”
A drug called sacituzumab govitecan (Trodelvi) is approved for TNBC that was treated but has spread to other parts of your body or that can’t be removed with surgery.
One study compared this drug to chemotherapy. “We saw such remarkable effects, not only for delaying the amount of time it took for cancer to grow, but also for twice as long as people lived,” Kalinsky said.
watch online replays of “Triple-Negative Breast Cancer: How We’re Learning to Treat It More Effectively.”
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