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About 20% of people with breast cancer have a type called triple negative breast cancer (TNBC).
It generally has a worse prognosis than other breast cancers. It also tends to affect non-Hispanic black women and women under 40 more frequently. But it can be more difficult to treat because some common cancer treatments, such as antihormonals and anti-HER2, do not work with TNBC.
On the WebMD webinar “Triple negative breast cancer: how we are learning to treat it more effectively” Kevin Kalinsky, MD, explained how TNBC is different and how new treatments are giving hope.
Most people with TNBC were interested in empowering themselves with information about their type of cancer or choosing a treatment plan.
More than half of those surveyed said that spending quality time with family and friends is the type of self-care that interests them most as part of a cancer treatment plan.
“Do older people get triple negative breast cancer? Is the treatment different for them than it is for the younger women who receive it?”
“How does TNBC affect the ability to have children? What about its impact on lactation?”
We can also see triple negative breast cancer in older people. It is important for us to define what we mean by “older”. For example, over 70 years.
The most common subtype of breast cancer overall 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 can also have other health problems. Treatment depends on the person’s health. We make an individual treatment plan for each person. If we have a very healthy person who is older, we will often have a similar approach for a younger person.
As for its impact on having children: With chemotherapy during early-stage breast cancer, you can take a drug that tells your brain to tell your ovaries to stop making estrogen. It is safe to do this and we know that it can preserve fertility. For premenopausal people, this is always something we mention. We also often have a person see fertility doctors.
We like that there is a window from the time a person with TNBC has surgery to the time they try to get pregnant. That’s about 2 years.
For people with TNBC who have metastatic disease, which means it has spread to other parts of the body, we do not suggest that they become pregnant. This is because we provide therapies that are not safe during pregnancy.
As for breastfeeding, it depends on what’s going on at the time. If you are actively receiving chemotherapy, we generally do not recommend breastfeeding.
Immunotherapy is new. We don’t know the effect on fertility yet, but experts continue to study it.
What do you recommend to address the mental health impacts of having TNBC?”
“What are the main self-care tips you recommend for someone with TNBC? Do they make a difference in the prognosis?”
“What are the most important precautions in the first 5 years of TNBC diagnosis and treatment to prevent it from coming back?”
It is normal in our clinic to ask how people are doing. Some centers have more availability of therapists or psychiatrists than others. There are also social workers and spiritual health experts in some places.
Don’t underestimate this. It is important that you tell your provider if you have difficulties.
In terms of self-care, information is power. It is important to go to well established sites that provide accurate information. It’s also important to find a provider you feel comfortable with, someone you trust, and someone you communicate with in a helpful way.
Especially on that first date, bring a loved one, friend, or family member because you may have a lot of anxiety. Having someone with you to listen and gather information can be critical. Also, think about some non-Western medical options. Experts can guide you through these to help complement some of the treatments you may receive.
Give yourself grace, 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 the breasts or nearby lymph nodes), the risk of recurrence is within the first 5 years. After those first 2 years, we took a deep breath. Then at the end of the 5 years, if there hasn’t been a recurrence, we can fully exhale.
This is different from patients who have estrogen-driven breast cancer, where we can see late recurrences after 5 years.
My general rule of thumb is: If you have a new symptom that is not otherwise explained and lasts 2 weeks or more, tell your doctor.
“Is there any benefit to taking immunotherapy for 2 years after treatment when there is no longer detectable cancer?”
“How can someone find clinical trials for triple negative breast cancer? Are they a good idea to participate?”
The standard is to take 1 year of 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 evaluated 1 versus 2 years. For people who have nothing inside the breast or lymph nodes at the time of surgery, the standard is to continue immunotherapy. But we don’t know if that’s necessary. There’s a big study that’s going to look at this to make sure we’re not over-treating people.
When it comes to clinical trials, I cannot stress how important it is to do so. The advances we have today are due solely to clinical trials. To find them, there is a website, Clinicaltrials.gov. You can type information like “triple negative” to help find one for you. The site will also find the ones near you.
It means that your breast cancer does not have these three receptors:
“Estrogen and progesterone are hormones that we all make, and those receptors are gates that allow the hormones to enter and feed a 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 don’t work for TNBC. “Without those receptors, treatments that block estrogen or HER2 are not effective,” Kalinsky 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 veins) tells your body to attack the cancer. It has been 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 there is a positive lymph node under the arm or the cancer is larger than 2 centimeters), doctors often give immunotherapy and chemotherapy before surgery.
PARP inhibitors. These are approved if you have metastatic breast cancer. They are oral medications (medications taken by mouth) and targeted therapies that block the enzyme known as PARP. This helps prevent cancers that have BRCA mutations from repairing their DNA and surviving. These treatments are approved for people who have BRCA mutations.
If you have HER2-negative (including TNBC) breast cancer and a BRCA mutation, you can take olaparib (Lynparza) for one year. Your doctor may also prescribe talazoparib (Talzenna).
“In one study, we clearly saw that there was a delay in cancer growth if people were given a PARP inhibitor compared to chemotherapy,” Kalinsky said.
Antibody-drug conjugates. This is a combination of chemotherapy and monoclonal antibodies. The antibodies bind to the protein on breast cancer cells and deliver the chemotherapy directly to the cancer.
“You can think of this as a GPS drug,” Kalinsky said.
“The antibody targets this protein and then directly delivers chemotherapy to the cancer cell instead of delivering chemotherapy to the veins.”
The drug, called sacituzumab govitecan (Trodelvy), is approved for TNBC that has been treated but has spread to other parts of your body or cannot be removed with surgery.
One study compared this drug with chemotherapy. “We saw such remarkable effects, not just from delays in terms of how long it took for cancer to grow, but also people living twice as long,” Kalinsky said.
Watch an online replay of “Triple Negative Breast Cancer: How We’re Learning to Treat It More Effectively”.
Look other free webinars from WebMD by leading experts on a variety of topics.
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