How to learn to manage more effectively
About 20% of people with breast cancer have a type, the so-called triple negative breast cancer (TNBC).
It generally has a worse outlook than other breast cancers. It also tends to influence non-Hispanic black women and women under 40 more often. But it can be harder to treat because some common cancer treatments, such as anti-hormone and anti-HER2, don’t work with TNBC.
On the WebMD Webinar “Triple-negative breast cancer: how to learn to treat it more effectively” Kevin Kalinsky, MD, explained what makes TNBC different and what new treatments offer hope for.
Most people with TNBC were interested in getting information about their type of cancer or choosing a treatment plan.
More than half of respondents said spending quality time with family and friends is the type of self-care they are most interested in as part of their cancer treatment plan.
“Do the elderly get triple negative breast cancer? Are they treated differently than younger women who get it?
“How does TNBC affect the ability to have children? What about its effect on breastfeeding?”
We can also see triple negative breast cancer in older people. It is important to define what we mean by “older”. For example, over 70 years.
The most common subtype of breast cancer is usually hormone receptor-positive, HER2-negative breast cancer. I think the prevalence of this form is even higher if you are over 70 years old. However, we also see people with TNBC in this subgroup.
As we age, other health problems may arise. Treatment depends on the person’s health. We create an individual treatment plan for each person. If we have a very healthy person who is older, we will often react similarly to a younger person.
As for its effect on childbearing: During chemotherapy for early-stage breast cancer, you may take a drug that tells your brain to tell your ovaries to stop producing estrogen. It’s safe to do this and we know it can preserve fertility. For those of us going through menopause, it’s always something we bring up. It often happens that we also turn to a fertility doctor.
We like that there is a window from when a person with TNBC has surgery to getting pregnant. That’s about 2 years.
TNBC patients who have metastatic disease, meaning it has spread to other parts of the body, are not recommended to become pregnant. This is because we give therapies that are not safe during pregnancy.
As for breastfeeding, it depends on what’s going on. Breastfeeding is generally not recommended if you are actively receiving chemotherapy.
Immunotherapy is new. The effect on fertility is not yet fully understood, but experts continue to study it.
“What does the Mental health effects of TNBC?”
“What are the best self-care tips for people with TNBC? Do they change the prognosis?”
“What are the most important precautions in the first 5 years of TNBC diagnosis and treatment to prevent disease recurrence?”
In our clinic, it is normal to ask how people are doing. Some centers have more therapists or psychiatrists available than others. Some places also have social workers and mental health experts.
Don’t underestimate this. It is important to let your provider know if you are experiencing difficulties.
In terms of self-care, information is power. It’s important to look for well-established websites that provide accurate information. It’s also important to find a provider you feel comfortable with – someone you trust and someone who communicates helpfully.
Especially at the first appointment, bring your loved one, friend or family member with you, as they may have a lot of anxiety. Having someone to listen and gather information can be critical. Consider some non-Western medical options as well. Experts can help with these to complement some of the treatments you may be receiving.
Give yourself grace, especially in the beginning when things can be very stressful.
As far as precautions are concerned, I-III. For patients with stage 1 TNBC (meaning it has not spread beyond the breasts or nearby lymph nodes), the risk of recurrence is within the first 5 years. After the first 2 years, we take a deep breath. Then by the end of the 5 years, if there is no recurrence, we can exhale completely.
This is in contrast to patients with estrogen-induced breast cancer, where we may experience late recurrence after 5 years.
My rule of thumb is this: If you have new symptoms that are unexplained and last 2 weeks or more, let your doctor know.
Is there an advantage to taking immunotherapy for 2 years after treatment, if there is no longer any detectable cancer?
“How does one find clinical trials for triple negative breast cancer? Is it a good idea to participate?”
According to the standard, 1 year Immune therapy for patients with stage 2 TNBC.
Immunotherapy is started with chemotherapy before surgery. Regardless of what we see at the time of surgery, they continue immunotherapy for a full year, including the time before surgery.
But we haven’t evaluated 1 vs. 2 yet. For people who have nothing in the breast or lymph nodes at the time of surgery, it is common to continue immunotherapy. But we don’t know if it’s necessary. There’s a big study looking at this to make sure we’re not overtreating people.
As for clinical trials, I cannot stress how important it is to do them. Today’s developments are purely due to clinical trials. There is a website to find these called Clinicaltrials.gov. You can enter information such as “triple negative” to help you find the right one for you. The site also finds those that are close to you.
This means that your breast cancer lacks these three receptors:
“Estrogen and progesterone are hormones that we all produce, and these receptors are doors that allow the hormones to come in and feed the cancer cell,” Kalinsky said. HER2 is a gene that helps breast cancer cells grow.
There are pills that target estrogen, as well as intravenous (IV) and subcutaneous (under the skin) treatments that target HER2. But they don’t work for TNBC. “Without these receptors, treatments that block estrogen or HER2 are ineffective,” Kalinsky said.
Some drugs have recently been approved to treat people with early-stage and metastatic TNBC. They include:
Immune therapy. This intravenous (IV) treatment (meaning it goes into your veins) tells your body to attack the cancer. It is approved for many forms of cancer.
Pembrolizumab (Keytruda) is currently approved for patients with metastatic TNBC whose tumors express a protein on cancer cells called PD-L1.
II–III. For stage 1 TNBC (meaning you have a positive lymph node under your arm or the cancer is larger than 2 centimeters), doctors often give immunotherapy and chemotherapy before surgery.
PARP inhibitors. These are allowed if you have metastatic breast cancer. These include oral medications (medicines taken by mouth) and targeted therapies that block an enzyme known as PARP. This helps prevent cancer with BRCA mutations from repairing its DNA and surviving. These treatments are approved for patients who have BRCA mutations.
If you have HER2-negative breast cancer (which includes TNBC) and a BRCA mutation, you can take olaparib (Lynparza) for one year. Your doctor may also prescribe talazoparib (Talzenna).
“In one study, we clearly saw that cancer growth was delayed when people received a PARP inhibitor compared to chemotherapy,” Kalinsky said.
Antibody drug conjugates. It is a combination of chemotherapy and monoclonal antibodies. The antibodies attach to a protein on the breast cancer cells and deliver the chemotherapy directly to the cancer.
“You can think of it as a GPS,” Kalinsky said.
“The antibody targets this protein and then delivers the chemotherapy directly to the cancer cell, instead of giving chemotherapy into the veins.”
A drug called sacituzumab govitecan (Trodelvy) is approved for TNBC that has been treated but has spread to other parts of the body or cannot be removed with surgery.
One study compared this drug to chemotherapy. “We saw such remarkable effects, not only because of the delay in the time it took for the cancer to grow, but people lived twice as long,” Kalinsky said.
Watch the online replay “Triple Negative Breast Cancer: How to Learn to Treat It More Effectively.”
Look other free WebMD webinars by leading experts in many topics.