When doctors diagnose breast cancer, they look for three types of receptors -- estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) -- expressed in the breast cancer. These are what cause most breast cancers to grow. They're also what our doctors typically target when treating breast cancer.
But some breast cancer patients lack these receptors. When this happens, the breast cancer is called triple-negative. And, without any receptors, it can be more challenging to treat. This is why triple-negative breast cancer (TNBC) is one of the cancers we're focusing on as part of our Moon Shots Program to dramatically reduce cancer deaths.
We recently spoke with Naoto T. Ueno, M.D., Ph.D., section chief of Translational Breast Cancer Research in Breast Medical Oncology, to better understand TNBC. Here's what he had to say.
Are some people more likely to develop TNBC?
TNBC affects women and men of all races and ages. Compared to other types of breast cancer, we tend to see this disease more in premenopausal women than older women. We're still trying to understand why these groups are more likely to develop TNBC.
Triple-negative patients are more likely to have a BRCA1 or BRCA2 gene mutation compared to non-TNBC patients. But you can still develop TNBC even if you don't have the BRCA1 or BRCA2 mutation. We're still trying to understand the link between TNBC and BRCA.
How is TNBC typically treated?
It depends on several factors -- tumor size, if and where the cancer has metastasized, and other things we learn about the tumor from pathology reports.
In most cases, chemotherapy is the most effective option. Often, women undergo chemo, then surgery - either a lumpectomy or mastectomy. Some also undergo radiation therapy.
What progress are we making in offering more personalized TNBC treatment?
Through our Breast and Ovarian Cancers Moon Shot, we're looking at ways to personalize TNBC treatment more. For newly diagnosed patients whose cancer hasn't metastasized, we plan to use genomic testing of the tumor. This will allow us to find out who will respond well to treatment and who won't. If we can tell the patient's not going to respond to standard chemo, we can switch the patient to a novel treatment protocol before surgery. That way, we can get a better response before the surgery. This will be a game-changer if it works.
For these patients, we can classify their breast cancers differently to select the best treatment for them. We know TNBC isn't one disease, but right now it's treated as one. In the next phase, we'll be able to look at biomarkers to divide triple-negative cases based on disease characteristics. We'll use that to choose the best treatment for each patient.
What clinical trials are available at MD Anderson for TNBC patients?
For those who still have a lot of the cancer left after surgery, we're working on several clinical trials. These will allow patients to receive a new targeted therapy combined with chemo before surgery.
For those with metastatic disease, we have many exciting new targeted therapies and immunotherapy-based clinical trials.
Because each trial has very different eligibility requirements, it's important to talk to your primary oncologists about your options.
What's your advice for newly diagnosed TNBC patients?
TNBC tends to be aggressive, so find out what stage you're at. Ask if the cancer has metastasized.
If your TNBC is resistant to chemotherapy or has metastasized, look into clinical trials. Be sure you know and weigh all of your treatment options.
If your cancer hasn't metastasized, ask if you need surgery or chemo first. TNBC generally responds to chemo, but the disease often comes back. This is why it's important to get input from both your surgical oncologist and medical oncologist.
I strongly recommend getting multidisciplinary care someplace like MD Anderson. That way, your surgeon, oncologist and radiation oncologist can work together closely throughout your treatment. A team approach is the best way to ensure every aspect of your care has been taken care of.
Triple-negative breast cancer is one of the areas MD Anderson is focusing on as part of our Moon Shots Program to dramatically reduce cancer deaths. Learn more about our Breast and Ovarian Cancers Moon Shot.