Triple Negative Breast Cancer

Treatment Options

Your treatment plan will be just as individual as your diagnosis, and your doctor will consider many factors before recommending the best treatment options for you, including your pathology and other test results; features of your tumor, including its size and location; lymph node involvement; tumor grade; and genetic testing results.

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

Surgery

Surgery is the primary treatment for most breast cancers. A lumpectomy is 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, which is surgery to remove the entire breast, is often done for large tumors (see Figure 2). Some people with a small tumor may choose a mastectomy to ease their worry about watching out for cancer 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 has spread to the skin or if you’ve already had breast cancer in the same breast.

Figure 2.

 

With either lumpectomy or mastectomy surgery for triple negative breast cancer, the surgeon will also remove lymph nodes in the underarm area. A pathologist will examine the nodes for cancer cells. This step is called lymph node staging and helps doctors determine the extent of the breast cancer. If you do not have any bulky or obvious cancer-containing lymph nodes in your underarm, your surgeon can focus on removing only the few most important lymph nodes, called the sentinel lymph nodes. Some patients require a more extensive lymph node operation to control their disease, called an axillary lymph node dissection (see Figure 1). The axillary lymph node dissection can leave patients at risk for a problem called lymphedema, which is swelling of the arm. The axillary surgery plan that is most appropriate for your cancer will be based upon several factors, including the extent of your disease and other treatments that you receive, such as radiation therapy and chemotherapy.

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.

Some triple negative breast cancer patients, especially those who have been found to have BRCA mutations and/or hereditary breast cancer, may consider additional surgical procedures. These women have a higher-than-average risk for developing new cancers in the contralateral (opposite) breast, the ovaries or the fallopian tubes. They may, therefore, 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 causes permanent infertility (the inability to have children) and premature menopause when performed in young women, as well as potential risks to bone and heart health. Contralateral prophylactic mastectomy can increase surgical complication rates and obviously alters body image. Talk to your doctor about these potential options before deciding if surgery is right for you.

Radiation Therapy

The most common type of radiation therapy for triple negative breast cancer is external-beam radiation therapy (EBRT). With this type of therapy, radiation is delivered from an external machine. Internal radiation, or brachytherapy, may also be used either alone or in combination with EBRT. 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 hidden in normal-appearing breast tissue. 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 is sometimes necessary after a mastectomy and is typically recommended for individuals at high risk for cancer recurrence on the chest wall, such as women with inflammatory breast cancer or women with cancer in several axillary lymph nodes. Radiation therapy is also used to control symptoms in some metastatic breast cancer patients with selected cases of bone or brain metastases.

Chemotherapy

Chemotherapy is often necessary 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 they may be given in combination with each other or sequentially (one after the other) over a specific period (usually three to six months). The chemotherapy regimens used most often are anthracycline-based or taxane-based.

When chemotherapy is given before surgery, it is known as neoadjuvant (preoperative) 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. Neoadjuvant chemotherapy is also often used in patients where cancerous axillary (armpit) lymph nodes are found at the time of initial breast cancer diagnosis, by axillary ultrasound and ultrasound-guided needle biopsy. The pathology findings from the breast and lymph node tissue removed after neoadjuvant chemotherapy provides important clues regarding prognosis (outlook). If the pathology report shows that the chemotherapy completely sterilized the cancer (called a complete pathologic response), this indicates that the chemotherapy regimen was very effective against that patient’s disease, and long-term survival rates are excellent, even with triple negative breast cancers. For triple negative breast cancers that have residual disease after neoadjuvant chemotherapy, recent research shows that additional medication can improve outcomes.

Chemotherapy given after surgery is known as adjuvant chemotherapy. The goal is to destroy cancer cells that may remain after surgery, some of which may be too small to detect with laboratory testing or imaging studies. Adjuvant chemotherapy is typically recommended for triple negative breast cancers found to be larger than one centimeter in the lumpectomy or mastectomy specimen, and/or in patients found to have cancer in surgically-removed axillary 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 due to neutropenia, but you may be able to manage or minimize them. Discuss the advantages and disadvantages of chemotherapy drugs with your medical team so you can know what to expect and make an informed decision.

Clinical Trials

Triple negative breast cancer, with its distinctive characteristics, is an ongoing focus of cancer research. Researchers and doctors are learning more about the disease and how it responds to treatment, making clinical trials a valuable, potentially life-saving treatment option to consider.

Clinical trials offer access to treatments that may work for some triple negative breast cancers, and new treatment options being studied include targeted therapy and immunotherapy. No targeted therapy or immunotherapy options have been approved yet, but some that have shown promise in clinical trials include the targeted therapies poly (ADP-ribose) polymerase (PARP) inhibitors, vascular endothelial growth factor (VEGF) inhibitors, androgen receptor blockade, PI3 kinase inhibitors, and epidermal growth factor receptor (EGFR) inhibitors, and immunotherapies known as immune checkpoint inhibitors.

There are many reasons to consider participating in a clinical trial:

  • Your current treatment may not be working as well as expected.
  • A clinical trial may significantly improve your quality of life. Discuss your personal situation with your medical team, so they understand your expectations for side effects.
  • By simply participating, you play an integral role in helping refine and improve the way millions of people with cancer are treated.

Successes from other clinical trial participants may inspire you to volunteer. Keep in mind that not everyone responds to treatments in the same way, so you cannot expect an identical experience in response to treatment or side effects.

You can research clinical trials at any time during your treatment. Regardless of when you enroll in a trial, participating will not jeopardize your guarantee to receive the standard of care.

Following are resources where you can search for clinical trials and learn more about them:

Additonal Resources

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