How we learn to deal with it more effectively
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. It also tends to affect non-Hispanic black women and women under 40 more often. But it can be harder to treat because some common cancer treatments, like anti-hormones and anti-HER2, don’t work with TNBC.
In the WebMD webinar “Triple negative breast cancer: how we learn to treat it more effectively”, Kevin Kalinsky, MD, explained how TNBC is different and how new treatments are giving hope.
Most people with TNBC either wanted to learn about their type of cancer or choose a treatment plan.
More than half of respondents said that spending quality time with family and friends is the type of self-care they are most interested in as part of a cancer treatment plan.
“Do older people get triple negative breast cancer? Is the treatment different for them than for the younger women who receive it? »
“How does TNBC affect the ability to have children? What about its impact on breastfeeding?
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 old.
The most common subtype of breast cancer in general is hormone receptor-positive, HER2-negative breast cancer. I think the prevalence of this form is even higher if you are over 70. However, we also see people with TNBC in this subgroup.
As we age, we may also have other health problems. Treatment depends on the health of the person. We establish an individual treatment plan for each person. If we have a very healthy elderly person, we will often have a similar approach to a younger person.
As for its impact on having children: With chemotherapy in the early stage of breast cancer, you can take a drug that tells your brain to tell your ovaries to stop producing estrogen. It’s safe to do, and we know it can preserve fertility. For pre-menopausal people, it’s always something we talk about. Often, a person also sees fertility doctors.
We love that there is a window between when someone with TNBC has surgery and when they try to get pregnant. It’s about 2 years.
For people with TNBC who have metastatic disease, meaning it has spread to other parts of the body, we are not suggesting that they get pregnant. This is because we give therapies that are not safe during pregnancy.
In terms of breastfeeding, it depends on what’s going on at the time. If you are actively undergoing chemotherapy, we generally do not recommend breastfeeding.
Immunotherapy is new. We don’t quite know the effect on fertility yet, but experts are continuing to study this.
“What do you recommend to solve the problem?” mental health impacts of having TNBC?”
“What are the best self-care tips you recommend for someone with TNBC? Do they make a difference in prognosis?”
“What are the most important precautions during the first 5 years of diagnosis and treatment of TNBC to prevent it from coming back?”
It is normal in our clinic to ask how people are doing. Some centers have more therapists or psychiatrists available than others. There are also social workers and spiritual health experts at some locations.
Don’t underestimate this. It is important to let your provider know if you experience any difficulties.
In terms of personal care, information is power. It is important to go to well-established sites that give accurate information. It’s also important to find a provider you feel comfortable with – someone you trust and someone who communicates in a helpful way.
Especially on that first date, bring a loved one, friend, or family member with you, as you may have a lot of anxiety. Having someone with you to hear and gather information can be essential. Also consider some non-Western medical options. Experts can guide you through these steps to help you complete 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 your breasts or nearby lymph nodes), the risk of recurrence is in the first 5 years. After these first 2 years, we breathe deeply. Then, at the end of the 5 years, if there has been no recurrence, one can expire completely.
This is different from patients who have estrogen-induced breast cancer where we can see late recurrences after 5 years.
My general rule of thumb is: if you have a new, unexplained symptom that lasts 2 weeks or more, let your doctor know.
“Is there a benefit to taking immunotherapy for 2 years after treatment when there is no detectable cancer?”
“How can anyone find clinical trials for triple negative breast cancer? Are they a good idea to participate? »
The norm is to take 1 year of immunotherapy for patients with stage II to III TNBC.
They start immunotherapy with chemotherapy before having surgery. Regardless of what we see at the time of surgery, they continue immunotherapy for a full year, including that period before surgery.
But we didn’t rate 1 vs. 2 years. For people who have nothing in the breast or lymph nodes at the time of surgery, the norm is to continue immunotherapy. But we don’t know if it’s necessary. There’s a huge study that will look at that to make sure we’re not over-treating people.
As for clinical trials, I can’t stress how important it is to do them. The progress we have today is only due to clinical trials. To find them, there is a website, clinicaltrials.gov. You can enter information such as “triple negative” to help you find one. The site will also find those 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 these receptors are gates that let hormones in 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 these receptors, giving treatments that block estrogen or HER2 aren’t effective,” Kalinsky said.
Some drugs have recently been approved to treat people with early and metastatic TNBC. They understand:
Immunotherapy. This intravenous (IV) treatment (meaning it goes through 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 if there is a positive lymph node under your arm or your 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. These are oral medications (medications you take by mouth) and targeted therapies that block the enzyme known as PARP. This helps prevent cancer that has BRCA mutations from repairing its DNA and surviving. These treatments are approved for people with BRCA mutations.
If you have HER2-negative breast cancer (which includes TNBC) and a BRCA mutation, you can take olaparib (Lynparza) for a year. Your doctor may also prescribe talazoparib (Talzenna).
“In one study, we clearly saw that there was a delay in cancer growth if people received a PARP inhibitor compared to chemotherapy,” Kalinsky said.
Antibody-drug conjugates. It is a combination of chemotherapy and monoclonal antibodies. The antibodies bind to the protein in breast cancer cells and deliver the chemotherapy directly to the cancer.
“You can think of it as GPS medicine,” Kalinsky said.
“The antibody targets this protein and then delivers the chemotherapy directly to the cancer cell instead of delivering the chemotherapy to the veins.”
The drug, called sacituzumab govitecan (Trodelvy), has been 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 to chemotherapy. “We found such notable effects, not only for delays in the time it took for cancer to grow, but also that people lived twice as long,” Kalinsky said.
Watch an online replay of “Triple negative breast cancer: how we learn to treat it more effectively.”
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