Triple Negative Breast Cancer Treatment Implications

Triple Negative Breast Cancer Treatment Implications


>>>Dr. Margileth: Whenever we see a breast
cancer, we do testing of estrogen receptor, progesterone receptor, and a growth regulatory
gene called HER2/neu gene. One of the more aggressive and more difficult types of breast
cancer to treat is what is called the triple negative breast cancer, that is the estrogen
receptor, the progesterone receptor, and the HER2/neu gene analyses are all negative. The first implication of this is that triple
negative breast cancer is more common in younger women and especially more common in women
that harbour what is called the BRCA 1 gene, so that whenever we see a women, certainly
under 50 and may be even under 60 with a triple negative breast cancer, one should strongly
consider seeing a genetics counselor for BRCA gene testing. In that the tumor is triple negative, we do
not have the option of using antiestrogen therapy, such as Tamoxifen or the aromatase
inhibitors and obviously we do not have the option of using Herceptin since the patient
is HER2 negative. So we would need to rely solely on chemotherapy as the effective treatment
of that disease. The triple negative tumors tend to be more
aggressive and therefore possibly less sensitive to chemotherapy and therefore especially,
in a young woman with a triple negative tumor, especially with positive nodes, we would generally
use one of the more aggressive chemotherapy regimens incorporating such agents as Adriamycin
and Cytoxan and Taxol. The cure rate of this, if node negative is
quite good. If there are a few positive nodes, the cure rate should be 70-80%. On the other
hand, if there are over 10 positive nodes that generally implies that the patient may
do well for some period of time but her risk of recurrence is quite high. So after an appropriate chemotherapy regimen
and appropriate local therapy, either mastectomy or lumpectomy and radiation, these patients
need to be followed very closely. There is a lot of controversy about what is
the best way to follow patients with breast cancer. If the patient has chosen lumpectomy,
obviously that patient need sequential mammograms, often the radiotherapist will want to do a
mammogram six months or so after the lumpectomy but after that yearly mammograms would be
appropriate. Clinical followup should be done generally
by the oncologist who gave the chemotherapy, on a schedule of every three to four months
for the first year or two, every six months for the next couple of years, and then after
five years when the risk of this recurrence falls quite a bit, one can then go to yearly
followup. There is a lot of controversy about whether
one should do blood tests. If you look at the signs of it, it is generally not proven
that the blood tests are helpful but many oncologists, in the hope of picking up a recurrence
early, will do such tests. In general, scanning is not indicated, in other words getting bone
scans or brain scans or PET scans on some kind of routines sequential basis generally
is not recommended. What one should do, however, if the patient has some complaint that in
fact may be indicative of recurrence then any tests that needs to be done to determine
that obviously should be performed. So one needs to be alert for various symptoms
such as shortness of breath, bone pain, weight loss, neurologic symptoms, skin nodules on
the chest wall, lymph node swelling, and anything else that seems to persists for a month or
two and is causing the patient trouble. What I tell patients is if there is something that
last for longer than a month or so and is becoming persistent and especially if it is
progressive, we will see that patient between visits and try to ascertain what is going
on? The other big dilemma here is there have been
several trials asking the question if we test aggressively with multiple blood tests, multiple
routine scans, and pick up a recurrence possibly three to six months sooner than we might otherwise,
does that imply that the ultimate survival is better. Unfortunately, that has not turned out to
be the case. There is no evidence to date that by picking up a recurrence three to six
months sooner than what would by clinical exam or complaints from the patient that our
treatments are anymore effective. So that doing lots of blood tests, and especially
lots of scans, really is not very helpful in the long run and in fact has its on set
of problems in what is called false positive test. If a patient has a routine, for instance PET
CT scan, often will find things on the PET CT scan that are indeterminate. They do not
necessarily look like cancer but we are not positive whether they are cancer or not, the
patient is upset, the family is upset, we are then left in a situation of trying to
determine what to do about this? Should we biopsy it? Should we repeat the scan in two
or three months? So that routine scanning often not only is not helpful but is counterproductive.
So the best thing to do is close clinical followup and followup of any persistent complaints. ***** Hi, I am Dr. Jay Harness and I want to share
with you an important information that I believe that every newly diagnosed patient with breast
cancer needs to know. Susan Denver: “I am a breast cancer survivor.” Katherine Stockton: “I am a breast cancer
survivor.” Coree: “I am a breast cancer survivor…” Susan Denver: “…and I want every woman
to know…” Katherine Stockton: “…about personalized
breast cancer treatment…” Susan Denver: “…and the Genomic Test.” Coree: “A test that helps guide a woman
and her doctor…” Katherine Stockton: “…to the best treatment
options for her.” Susan Denver: “Pass it on!”

3 comments

  1. Survivor of triple neg breast cancer, had breast cancer in early 30's, BRCA1 gene. My beautiful mam died of ovarian cancer, her mother too. My sister had fallopean tube cancer. None of my mam's sisters', or any of my cousins' have had it. Strange thing are genes! R.I.P Philomena, x

  2. Well i have TNBC and i am on Letrozil 2 why is this , this scares me , im 55 i dont want to die ,

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