Triple Negative Breast Cancer

Treatment Options

Each breast cancer is unique, and so is each person's response to treatment. After learning more about your triple-negative breast cancer from your pathology report and other test results, your doctor will determine the best treatment plan for you based on the following:

  • Features of your tumor, including its size and location
  • Lymph node involvement
  • Tumor grade
  • Genetic testing results

Triple-negative breast cancer is typically treated with a combination of surgery, radiation therapy and/or chemotherapy. Clinical trials also offer access to cutting-edge treatments that are being studied. In addition to educating yourself about the options available to you, talking with other survivors of triple-negative breast cancer can be helpful in making treatment decisions.

Surgery

For most breast cancers, surgery is the primary treatment. A lumpectomy is a surgery known as “breast-conserving treatment” because most of the breast is left intact. The surgeon removes only the tumor (lump) and a small amount of healthy tissue around the lump (see Figure 1). Lumpectomy can be done for most small tumors.

Figure 1.

 

A mastectomy, surgery to remove the entire breast, is often done for large tumors (Figure 2). Some people with a small tumor may choose a mastectomy to ease their worry about monitoring the breast for recurrence, and some choose this option as a way to potentially avoid radiation therapy. Your doctor may recommend a mastectomy if you have a large tumor, multiple tumors in the breast, cancer that involves the nipple or has spread to the skin or if you’ve already had breast cancer in the same breast.

Figure 2.

 

During either surgery, the surgeon may also remove lymph nodes under the arm. A pathologist will examine the nodes for cancer cells. This step is called lymph node staging and helps doctors determine the stage of the breast cancer. To remove as few lymph nodes as possible when suspicious nodes are not felt on physical examination, surgeons use a procedure called sentinel lymph node biopsy, which helps determine if and where cancer has spread. If cancer cells are found in the sentinel lymph node (the closest node to which the cancer has most likely spread), nearby lymph nodes are usually removed. If no cancer cells are found in the sentinel node, it’s unlikely that cancer cells have spread to farther lymph nodes. After a mastectomy, you have many options for reconstructive surgery. This is usually done by a plastic surgeon who rebuilds the breast to make it look as much as possible like it did before surgery.

Other types of surgery may be appropriate, especially for women in whom hereditary breast cancer has been identified. These women have a higher-than-average risk for cancer in the contralateral (opposite) breast, ovaries or fallopian tubes and may choose to have prophylactic (preventive) removal of the ovaries and fallopian tubes or of the opposite breast as a precaution against future cancer. Removal of the ovaries has substantial side effects, such as infertility (the inability to have children), potential risks to bone and heart health, early menopause and negative body image. Talk to your doctor about all of these risks before deciding if surgery is right for you.

Radiation therapy

External-beam radiation therapy is the most common type of radiation therapy for triple-negative breast cancer. With this type of therapy, radiation is delivered from an external machine. Internal radiation, or brachytherapy, may be used either alone or in combination with external-beam radiation. Brachytherapy involves placing radioactive seeds through a catheter in the breast to deliver radiation directly to the area where the tumor was removed.

Radiation therapy is almost always done after lumpectomy to destroy any cancer cells that may remain. Research shows that women with a small tumor who have radiation therapy after a lumpectomy live as long as those who have a mastectomy. Radiation therapy may also be done after a mastectomy and is typically recommended for women at high risk for cancer recurrence. If the breast cancer has metastasized (spread), radiation therapy may be used to treat symptoms of metastasis.

 

Genetic Testing

Triple-negative breast cancer is associated with mutations in the BRCA1 and BRCA2 genes. Knowing whether you have a mutation in one of these genes is valuable for two reasons: choosing treatment and assessing your family’s cancer risk.

Genetic profiling for treatment

Experts recommend that people with TNBC under age 60 be tested for BRCA mutations. If you have a BRCA mutation, some treatments may be more effective for you. Your health care team will work closely with you to determine the best treatment plan for your TNBC. Additionally, a BRCA mutation puts you at a higher risk for cancer in the other breast and ovarian cancer. If you have a BRCA mutation, you can learn about ways to lower your risk for those cancers. Research is being done to find better ways to detect, treat and prevent cancer in people with BRCA mutations.

Genetic testing for your family’s risk

If you have a BRCA mutation, your family members may also carry the mutation. A genetic counselor can discuss the risks and benefits of genetic testing to help you and your family decide if it is appropriate for your family members. A genetic counselor can also explain the results of genetic testing, which can sometimes be complicated.

Most experts recommend against testing children under 18 for BRCA mutations because no safe, effective therapies to prevent breast cancer in children currently exist. Moreover, children are not old enough to decide whether they want to know about their cancer risk.

Ask your doctor about genetic testing, and visit the following websites to learn more:

Chemotherapy

Chemotherapy is typically the most effective treatment for triple-negative breast cancer. Research has shown that triple-negative breast cancer may respond better to chemotherapy than other types of breast cancer. Several chemotherapy drugs are available and may be given as a combination of drugs, either together or one after the other (sequentially) over a specific period (usually three to six months).

Chemotherapy may be given before surgery, known as neoadjuvant chemotherapy, or after surgery, known as adjuvant chemotherapy. Neoadjuvant chemotherapy may be used to shrink a tumor so that it can be surgically removed or to shrink a large breast tumor to allow for lumpectomy rather than a mastectomy. Chemotherapy may also be used as the primary treatment for triple-negative breast cancer that has spread beyond the breast and nearby nodes, in which case the regimen and schedule will depend on how the cancer responds and the side effects of treatment.

Adjuvant chemotherapy is given to destroy cancer cells that may remain after surgery, some of which may be too small to detect with laboratory testing or imaging studies. It is typically recommended for patients with a high risk of recurrence, such as those with cancer in the lymph nodes.

Disease responds differently to chemotherapy in every patient, and certain drugs may be more effective for you. If your disease doesn’t respond as expected to one chemotherapy drug, your doctor may recommend another. Researchers continue to study various chemotherapy combinations and the genetic makeup of tumors to determine which regimens work best against the specific characteristics of different tumor types.

Chemotherapy often causes side effects such as nausea, hair loss and increased risk of infection, but many patients can continue most of their usual activities. Discuss the advantages and disadvantages of chemotherapy drugs with your medical team so you can make an informed decision.

Clinical trials

The cancer treatments in use today are the result of clinical trials, research studies that explore whether a medical strategy, treatment or device is safe and effective. Triple-negative breast cancer is an ongoing focus of cancer research. New treatment options are being studied, with much of the development in targeted therapy and immunotherapy.

When you volunteer to participate, you will receive specific instructions. Ask questions about anything you don’t fully understand. This is the ideal time to talk with your medical team about misconceptions about clinical trials. For example, although there is fear to the contrary, participants are guaranteed to receive at minimum the current standard of care during the trial.

All enrolled patients in a clinical trial are treated exactly the same. Whether you’re at a small rural hospital or a large facility in a metropolitan area, your medical team must diligently follow all the safety measures for your treatment plan. You will be carefully monitored throughout the clinical trial. Even after treatment ends, you will be in close contact with the medical team.

Immunotherapy

The immune system naturally protects the body by attacking germs, but cancer cells have a unique ability to withstand those attacks and to inhibit the immune system. Immunotherapy uses drugs to activate the immune system to block the cancer cells’ immune-inhibiting mechanisms, which stops or slows the growth of cancer. Something that separates immunotherapy from traditional treatments is its “memory,” the ability to remain effective long after treatment ends.

Successes in treating melanoma and lung cancer with immunotherapy have encouraged scientists to continue studying ways to treat triple-negative breast cancer with immunotherapy.

Targeted Therapy

Targeted therapy is treatment with drugs or other substances that block the growth and progression of cancer by interfering with specific molecules on or in the cancer cell. There are currently no approved targeted therapies for triple-negative breast cancer, but promising treatments in clinical trials include poly (ADP-ribose) polymerase (PARP) inhibitors, VEGF (vascular endothelial growth factor) inhibitors, androgen receptor blockade, PI3 kinase inhibitors, EGFR (epidermal growth factor receptor) inhibitors and combination therapies that include chemotherapy.

Clinical trials offer access to treatments that could work for you. You also might consider volunteering for quality-of-life trials, which study ways to improve the quality of life for people with cancer and survivors who experience cancer- and treatment-related symptoms. You may be a candidate for prevention, screening and diagnostic trials, which assess ways to reduce the chance of getting a second cancer or having a recurrence.

If you are interested, ask your medical team or search for trials online with the following sites:

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