Breast cancer is usually treated with chemotherapy, sometimes combined with targeted therapies, which target the specific receptor causing the cancerous cells to grow. Those combinations are typically more effective. However, with TNBC, no such receptors exist; therefore, such an option is not available. However, as of summer 2021 , we will incorporate immunotherapy with chemotherapy for some newly diagnosed early-stage TNBC.
Surgery
Chemotherapy
Radiation Therapy
Further, to improve the long-term outcome, a combination of surgery, chemotherapy, and frequent radiation therapy is the primary treatment option for women with TNBC. After surgery to remove the cancerous cells, combination chemotherapy is given to help prevent recurrence. In some cases, chemotherapy will be administered before surgery in order to shrink the tumor and/or lymph nodes and facilitate the operation. This approach also allows for some patients to pursue conservation of the breast (with procedures such as lumpectomy) who would not otherwise be candidates to preserve the breast. Survival outcomes are the same regardless of whether the chemotherapy is given before or after the breast operation. Unlike targeted treatments which attack the particular receptor causing cancer growth, chemotherapy generally targets all fast-growing cells in the body, both cancerous and healthy.
For this reason, it is critical that you discuss chemotherapy in detail with your doctor so that you are more fully prepared for the treatment. While TNBC can often have an accelerated growth rate, the good news is that recurrence after 4-5 years is very unlikely. With TNBC, whereas tumors with estrogen receptors may recur even after 5-10 years. Also, many new agents are being tested to treat triple-negative cancers, including new chemotherapy combinations or immunotherapies that circumvent the need to target the estrogen or HER2 receptors. Clinical trials in these areas are ongoing, so it might be worthwhile to ask your physician about the possibility of participating in clinical trials of new agents.
Most women with breast cancer have breast-conserving surgery or a mastectomy to remove the tumor, along with lymph node surgery to check the lymph nodes for cancer that may have spread. The goal of surgery is to remove any cancerous cells, and it is typically combined with chemotherapy to prevent a recurrence. Some women may also decide to have reconstructive surgery after breast cancer surgery to remove the tumor.
Chemotherapy uses drugs to target rapidly growing cells in an effort to destroy cancer cells. Doctors give chemotherapy to shrink the tumor before surgery (neoadjuvant therapy) and destroy any traces of cancer left after surgery (adjuvant therapy). In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms and improve survival. Chemotherapy can be given intravenously, as a shot, or as a pill or liquid. Doctors usually use a combination of chemotherapy drugs and provide the treatment in cycles. This means that each round of treatment will be followed by a rest period of two or three weeks.
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Doctors give radiation therapy to shrink the tumor before surgery and eliminate any traces of cancer left after surgery. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. In internal radiation therapy, the doctor places radioactive pellets inside the body near the tumor.
Forms of immunotherapy commonly used to treat cancer include monoclonal antibodies and targeted therapies, which prevent the cancer cells from multiplying by enhancing your own immune system. Currently, these therapies are given to front-line treatment of the early-stage disease combined with chemotherapy. Also, it is given as the first treatment choice of metastatic disease.
Antibody–drug conjugates or ADCs are a class of biopharmaceutical drugs designed as a targeted therapy for treating cancer. Unlike chemotherapy, ADCs are intended to target and kill tumor cells while sparing healthy cells. Biopharmaceutical drugs contain substances that have been created by using living cells or organisms and is a new form of targeted treatment. PARP inhibitors are a type of targeted therapy that helps repair DNA damage in cells. PARP inhibitors work by preventing cancer cells from repairing, allowing them to die. Inhibitors of PARP preferentially kill cancer cells in BRCA-mutation cancer cell lines over normal cells. Your physician may recommend a PARP inhibitor if you have a BRAC mutation.
For patients with metastatic breast cancer your doctor may approach you about conducting a genetic testing of your tumors. These tests are different from testing your normal cells for examples like BRCA to understand the risk of development of the breast cancer. Rather these tests are conducted to lead the physicians to determine if you are appropriate for certain targeted therapy. these treatments are generally under tested in clinical trials. It is important to discuss with your doctor whether you are appropriate for your tumor to be tested for genomic testing.
Clinical trials allow patients to try a new treatment before it is available to the general public. Each study is structured to answer specific scientific questions and to develop better ways to help treat cancer patients. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
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