Health

Understanding triple-negative breast cancer and its treatment

There are a number of breast cancer subtypes. The progress of hormone-dependent breast cancer, the most typical subtype, is pushed by feminine hormones. Another frequent subtype, HER2-positive breast cancer, has extreme copies of a gene known as HER2 that makes its cells develop greater than they need to.

Triple-negative breast cancer, additionally known as basal-like breast cancer, is a subtype that is not affected by hormones or the HER2 gene. It grows quickly, is extra more likely to unfold past the breast earlier than prognosis and is extra more likely to recur than different breast cancers.

Roberto Leon Ferre, M.D., a Mayo Clinic oncologist whose analysis focuses on triple-negative breast cancer, says latest advances are bettering treatment outcomes for folks with this illness. “This subtype represents about 15% of all breast cancers,” says Dr. Leon Ferre.

“It’s a bit more common at younger ages and in African American women, Hispanic women and women of Indian descent. We also see this subtype more commonly in women who have a genetic mutation predisposing them to breast cancer — the BRCA1 mutation, in particular.”

ROBERTO LEON FERRE, M.D.

Dr. Leon Ferre and different researchers at Mayo Clinic are working to grasp how triple-negative breast cancer grows and spreads, how the immune system could acknowledge and struggle it, and to develop new therapies for the illness. If you’ve got been recognized with this breast cancer subtype, right here’s what you need to know:

What is triple-negative breast cancer?

Roberto Leon Ferre, M.D.

“We do three tests on every breast cancer tumor to help us select treatment: The estrogen receptor, progesterone receptor and HER2. If those three tests are negative, the cancer is considered triple-negative breast cancer,” says Dr. Leon Ferre.

Confirming a prognosis of triple-negative breast cancer begins with a biopsy, a process to take away a pattern of breast tissue for testing. Your care workforce will ship your tissue to the laboratory for evaluation to find out cell kind, aggressiveness (grade) and whether or not the cancer cells have hormone receptors.

Hormone receptors are proteins that may connect to a selected hormone. Some breast cancer cells have receptors for the feminine hormone estrogen and want it to develop. These breast cancers could be handled with anti-estrogen hormone (endocrine) remedy to dam their progress.

The lab may also analyze your cancer cells’ genetic make-up to find out if they’re HER2-positive or produce other tumor markers. HER2-positive cancers have too many copies of the HER2 gene, which causes them to supply an excessive amount of of the HER2 growth-promoting protein. These breast cancers could be handled with medication that focus on the HER2 protein in cancer cells to gradual these cells’ progress and kill them.

How is triple-negative breast cancer handled?

Dr. Leon Ferre says that for some varieties of breast cancer, chemotherapy is used after surgical procedure and typically in no way. This just isn’t the case for triple-negative breast cancer. “The vast majority of women with this diagnosis will need chemotherapy, and we almost always treat with chemotherapy before surgery,” he says.

With different breast cancers, chemotherapy is given after surgical procedure to kill any cancer cells which will have unfold past the breast.

“Triple-negative breast cancer tends to spread at a microscopic level from the beginning,” says Dr. Leon Ferre. This means the cancer should be handled with systemic therapy — a drug or mixture of medicine that may be taken orally or by an IV to achieve cancer cells in all elements of the body. “The drugs usually used to avoid chemotherapy target estrogen receptors. This cancer doesn’t have those, so we rely on chemotherapy, which essentially kills any cell that is dividing rapidly,” he says.

Another systemic remedy used to deal with triple-negative breast cancer is immunotherapy, medication that assist your immune system establish and kill cancer cells. “At this time, it’s the only type of breast cancer for which we use immunotherapy. Of all breast cancer subtypes, it’s the one that’s better able to alert the immune system to its presence. We can take advantage of that and use medications to activate the immune system further to attack the cancer,” says Dr. Leon Ferre.

“At this time, it’s the only type of breast cancer for which we use immunotherapy. Of all breast cancer subtypes, it’s the one that’s better able to alert the immune system to its presence. We can take advantage of that and use medications to activate the immune system further to attack the cancer.”

ROBERTO LEON FERRE, M.D.

The immunotherapy authorised for the treatment of triple-negative breast cancer is known as pembrolizumab. It can be utilized with chemotherapy or different medicines earlier than surgical procedure and then continued alone after surgical procedure to deal with early stage, triple-negative breast cancer at high threat of recurrence. It may also deal with triple-negative breast cancer that produces the PD-L1 protein and can’t be surgically eliminated.

Dr. Leon Ferre says genetic testing can establish further treatment choices for triple-negative breast cancer. “There are some medications that work only in people that have certain genetic mutations, so it’s important to ask for genetic testing — even if you don’t have a family history of breast cancer.”

What ought to I ask my care workforce about triple-negative breast cancer?

Before deciding on a treatment plan, Dr. Leon Ferre recommends asking your care workforce these questions:

  • What is the purpose of my treatment?
    He says everybody recognized with cancer ought to ask their care workforce this query. “It’s important to know if treatments are likely to cure the cancer or if treatment will be about controlling the cancer.”
  • Are scientific trials an choice?
    If obtainable therapies are unlikely to attain a remedy, take into account scientific trials. “There have been many advances in triple-negative breast cancer research, and there are a lot of newer medications that work against this cancer,” he says. Participating in a clinical trial could present treatment choices you might not in any other case have.
  • Is immunotherapy an choice?
    Immunotherapy can deal with cancer by blocking immune checkpoints, the a part of the immune system that stops an immune response from being so robust that it destroys a body’s healthy cells. Dr. Leon Ferre says you need to ask about immunotherapy in case your care workforce does not point out it. Depending on the state of affairs, you might want a check known as PD-L1 to determine if immunotherapy could be a superb choice.
  • What are the potential unintended effects of treatment?
    Before deciding on a treatment plan, it is essential to grasp the unintended effects of any treatment. “Understanding the potential side effects will help you anticipate how you will feel and prepare beforehand. Every cancer patient should ask about treatment side effects,” he says.

Are new therapies being developed for triple-negative breast cancer?

Researchers are finding out a number of new varieties of immunotherapy with the potential to deal with triple-negative breast cancer. “These therapies are promising, and because they work differently than the immunotherapy now available, they are likely to help patients that do not qualify for that drug,” says Dr. Leon Ferre. “We also have made progress in a class of drugs called antibody-drug conjugates. These treatments link a small amount of chemotherapy to modified antibodies — naturally occurring proteins that help fight infections. The antibodies have been modified to recognize specific portions of the tumor, instead of bacteria or viruses, and are attached to a small dose of chemotherapy. This allows chemotherapy delivery to tumor cells while sparing cells that aren’t cancerous. These drugs seem to be more potent than traditional chemotherapy.”

Researchers have additionally made advances within the growth of targeted therapies for triple-negative breast cancer. These medication goal proteins that management how cancer cells develop, divide and unfold. “These treatments are for patients with certain genetic mutations — some targeted therapies specifically block those mutations,” says Dr. Leon Ferre. “Some of these drugs are oral and have fewer side effects than traditional chemotherapy. So, we may be able to treat some patients with targeted-drug therapies and perhaps have phases of treatment where they don’t need chemotherapy. These drugs can be much better tolerated and usually don’t cause nausea or hair loss.”

Dr. Leon Ferre and his colleagues at Mayo Clinic are conducting clinical trials of focused therapies for triple-negative breast cancer. “We’re working on ways to identify patients that may do well with less or no chemotherapy. We’re finding immune markers that may allow us to identify patients with early stage cancer with such a good prognosis that they may need less intensive chemotherapy.”

“We’re working on ways to identify patients that may do well with less or no chemotherapy. We’re finding immune markers that may allow us to identify patients with early stage cancer with such a good prognosis that they may need less intensive chemotherapy.”ROBERTO LEON FERRE, M.D.

If you’ve got been recognized with triple-negative breast cancer, Dr. Leon Ferre needs you to know that it is treatable. “It’s very sensitive to chemotherapy. With the incorporation of immunotherapy and some newer drugs, we’re seeing higher cure rates for patients with early stage breast cancer. And we have new treatments for patients with metastatic breast cancer. We’re making a lot of progress.”

Learn extra

Learn extra about breast cancer and breast cancer types.

Find a triple-negative breast cancer clinical trial at Mayo Clinic.

Join the Breast Cancer Support Group on Mayo Clinic Connect, an internet neighborhood for sufferers and caregivers.

Also, learn these articles:

This article first appeared on the Mayo Clinic Comprehensive Cancer Center Blog.

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