A Closer Look at Treating Triple-Negative Breast Cancer

If you have been told that you have triple-negative breast cancer, it is natural to be frightened and uncertain. This type of breast cancer is not as prevalent as others and poses more significant challenges, but there is still hope for recovery. While the treatment options are limited, many cases can still be successfully treated, offering hope and positivity for you. It is important to seek guidance and support from your healthcare team and loved ones. They can provide you with the necessary resources to navigate this difficult time

Triple-negative breast cancer (TNBC) is breast cancer that tests negative for estrogen or progesterone receptors and makes little to none of the human epidermal growth factor receptor 2 (HER2) protein. Most breast cancer cells have receptors for the hormones estrogen or progesterone, which helps them to grow and are known to be hormone receptor-positive, estrogen receptor-positive, or progesterone receptor positive. These cancers can usually be treated with hormone therapy that prevents these hormones from binding to the cancer cells and thus slowing down or preventing their growth. Other cancer cells have high levels of the HER2 protein on their surfaces, promoting growth. This type of cancer is HER2-positive breast cancer and can typically be treated with drugs targeting HER2. TNBC tests negative for both these hormones and HER2, so the respective treatments do not work for TNBC. However, there are other methods to treat TNBC.

When treating TNBC, hormone therapy and targeted therapy are unlikely to be effective. Other treatment methods are used instead.

Chemotherapy

Chemotherapy is used differently depending on the size and stage of the cancer. Sometimes, it is used before surgery (neo-adjuvant chemotherapy) if:

• The tumor is too large and needs to be shrunk for surgery (lumpectomy or mastectomy) to be possible.
• Lymph nodes are found to have cancer.
• Cancer has spread to other body parts (stage IV breast cancer or metastatic breast cancer).

Chemotherapy can also be used after surgery (adjuvant chemotherapy):

• If the tumor is small.
• To reduce the risk of recurrence.
• Cancer is still found in the tissue post-surgery, despite undergoing neo-adjuvant chemotherapy before.

One or a combination of multiple chemotherapy drugs may be used to treat TNBC. Common ones include:

• Doxorubicin
• Epirubicin
• Paclitaxel
• Capecitabine
• Docetaxel
• Carboplatin
• Cisplatin

The type of drugs used will depend on each case and may be adjusted depending on treatment response.

Surgery

Surgery is a common treatment method, together with chemotherapy. Patients will typically either have a lumpectomy or a mastectomy for TNBC.

• Lumpectomy

Although TNBC is known to be an aggressive cancer, not all TNBCs have to be removed by a mastectomy. Tumors at an early stage, small enough or adequately shrunk by neo-adjuvant chemotherapy, may be treated by less invasive surgical options, including lumpectomy. This option is often favorable as it tends to have a lesser impact on patients.

• Mastectomy

A mastectomy will be performed in cases where a lumpectomy is not an option. Individuals with BRCA mutations or other high-risk factors may also be advised to undergo a mastectomy to minimize the risks of future recurrence.

Radiation therapy

Radiation therapy is usually given after surgery to kill any remaining cancer cells. Radiation therapy will be given after the full chemotherapy treatment is completed if adjuvant chemotherapy is necessary.

Newer medicines

• Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) can destroy cancer cells and are now FDA-approved to treat TNBC.
• Immunotherapy makes use of the body’s immune system to fight cancer. It is not normally used as the first treatment for TNBC, but it may be used in some cases, such as when the cancer stops responding to chemotherapy and other treatment methods are not possible. Antibiotic-drug conjugate is a novel approach that uses a monoclonal antibody, a potent chemotherapeutic, and a linker connecting the two. Such an approach has been shown to minimize drug toxicity and increase antitumor immunity (immunity to tumors). Antibody drug conjugates such as Sacituzumab may be used in the treatment of TNBC.

Coping with TNBC is a daunting and overwhelming experience. After all, breast cancer of this type is not as common and more complex to manage than others. However, it is crucial to understand that various treatment options are available to you. Maintaining a positive outlook and being knowledgeable about your options can be instrumental in overcoming the challenges associated with this diagnosis. By working closely with your healthcare team, you can establish a tailored treatment plan to facilitate your recovery journey. It is also important to remember that despite the challenges, it is still possible to regain your health and well-being. Therefore, do not lose hope and remain informed, optimistic, and resilient.