Bhuvaneswari Ramaswamy, MD, MRCP
Assistant Professor of Internal Medicine
Division of Medical Oncology
Arthur G. James Cancer Hospital and Richard. J. Solove Research Institute
Ohio State University
Please describe the defining characteristics of triple-negative breast cancer.
Triple-negative breast cancers account for about 15 percent of all breast cancers and are defined as breast cancers that are estrogen receptor– and progesterone receptor–negative, meaning that these cancers do not depend on estrogen for their growth. In addition, the HER2/neu gene is not amplified in these cancers. (When amplified HER2/neu produces a protein called HER2 that acts as an accelerator for growth when present in an abundance in cancer cells.)
What are the risk factors for triple-negative breast cancer?
There are no modifiable risk factors for triple-negative breast cancer. These cancers tend to occur more frequently in young premenopausal women, in African-American women, and in women who carry the abnormal inherited breast cancer susceptibility gene BRCA1.
Why is triple-negative breast cancer such a challenge to treat?
In general these tumors are more aggressive and grow at a rapid rate. There are two major challenges in treating these tumors: First, because they have no known targets (such as estrogen receptor or HER2/neu), currently the only way to treat them is to use chemotherapy, which generally results in more side effects. Second, even when we treat these tumors with chemotherapy, they may or may not respond; and when they do, the response is often short lived.
Are there specific questions that women should ask their healthcare team when they are diagnosed with triple-negative breast cancer?
The key question a woman who is diagnosed with triple-negative breast cancer should ask her doctor is whether an appropriate clinical trial exists for her diagnosis. There are some novel approaches to treat these cancers that are still in investigational stages but that hold great promise. It is important that patients make use of these opportunities when possible to increase their treatment options. In addition, patients should be sure to consult their healthcare team to see if genetic testing should be a consideration.
What has been the standard protocol for treating triple-negative breast cancer, and what treatments or innovations are on the horizon for this difficult-to-treat disease?
The standard protocol to treat early-stage triple-negative breast cancer confined to the breast and axillary lymph nodes is chemotherapy and surgery. Often chemotherapy is administered before surgery. At present there are no further treatment options for early-stage triple-negative breast cancer beyond close follow-up care with regular physical exams and mammograms.
There are, however, innovative approaches currently under study, including the addition of targeted therapy to this chemotherapy backbone. Ohio State University is currently conducting a study that will include a gamma secretase inhibitor along with chemotherapy to target the more resistant cells. Additional studies at other institutions are investigating agents like Avastin® (bevacizumab, a monoclonal antibody) and the impact of prescribing various therapies following chemotherapy and surgery to prevent a recurrence, particularly for tumors that did not respond to primary chemotherapy.
For advanced triple-negative breast cancer, the current standard approach is to treat with various chemotherapy regimens. The most recent breakthrough in the treatment of such tumors is the success story of PARP inhibitors. Short for poly (ADP-ribose) polymerase, PARP is an enzyme that is required for cells to repair the DNA damage induced by any form of injury (including radiation, UV rays, and chemotherapy). Unfortunately, the cancer cells also use this enzyme to correct the damage induced by chemotherapy, making that treatment less effective. Now researchers have shown that by including a drug that inhibits the PARP enzyme along with chemotherapy, they can cause more damage to triple-negative breast cancers than when chemotherapy is delivered alone.
Several clinical trials are currently under way at various centers, using different PARP inhibitors with different chemotherapy in triple-negative and genetically inherited breast cancers. At Ohio State University, we have a clinical trial in which a PARP inhibitor is used along with Paraplatin® (carboplatin) chemotherapy in women with advanced breast cancers.
For more information about triple-negative breast cancer clinical trials at OSUCCC-James, call the James Line at (800) 293-5066.
Reach Out for Help
If you’re facing a triple-negative diagnosis, consider contacting one of the following organizations for support and information.
Triple Negative Breast Cancer Foundation
Mission “Our mission is to raise awareness of triple negative breast cancer and to support scientists and researchers in their effort to determine the definitive causes of triple negative breast cancer, so that effective detection, diagnosis, prevention and treatment can be pursued and achieved.”
Helpline (877) 880-TNBC [8622] • TNBCHelpline@cancercare.org
The Triple Negative Breast Cancer Foundation has partnered with CancerCare to offer free, professional support services to patients, families, and health providers coping with a diagnosis of triple-negative breast cancer. The TNBC Helpline is staffed by experienced oncology social workers with specific knowledge of triple-negative disease. In addition to counseling, TNBC Helpline staff can assist callers in availing themselves of the various other services CancerCare has to offer, including, where appropriate, helping patients apply for co-pay assistance, transportation, and other social services.
Living Beyond Breast Cancer
Mission “To empower all women affected by breast cancer to live as long as possible with the best quality of life.”
Helpline (888) 753-LBBC [5222]
Helpline volunteers offer peer support, information, and hope in a confidential setting. A breast cancer survivor will answer the phone live on Tuesdays from 11:00 a.m. to 3:00 p.m. EST. At any other time, callers can leave a message, and a breast cancer survivor will return the call within 24 hours. Spanish-language speakers are available. Requests can also be made via an online e-mail response form. A personalized matching service is also available, connecting patients with someone facing a similar circumstance whose age and ethnic background are comparable.
Breast Cancer Network of Strength
Mission “To ensure, through information, empowerment, and peer support, that no one faces breast cancer alone.”
Helpline (800) 221-2141
The YourShoes 24/7 toll-free hotline is staffed by trained peer counselors who are breast cancer survivors. These peer counselors are experienced in handling all types of questions related to breast cancer and can discuss feelings and concerns. A personalized matching service is also available as is e-mail support through an online response form. Caregivers can also find support here through the Partner Match Program.
