Where is research on triple-negative breast cancer?


Question from Sally: The comments on triple-negative breast cancer were short and to the point. They did not come across as particularly hopeful. Can you share where the research is with these types of cancer, and how much it is being studied? Since it is less common, many of us with this diagnosis wonder how much effort is being given to these types of cancers.
Answers - Nicholas Robert, M.D. The comments about the new treatment of triple-negative breast cancer with a PARP inhibitor were meant to be very hopeful. Frankly, for those of us involved in breast cancer treatment, this was the most exciting information we've heard about triple-negative breast cancer for some years. We hope that this approach using PARP inhibitors will not only be of benefit for women who are being treated for metastatic breast cancer, but also for women with early breast cancer. One of the frustrations in cancer or any research is the amount of time it takes to develop better therapies. You should know that the triple-negative breast cancer subset has been a subject of many clinical trials, and it has attracted the attention and interest of many clinical investigators. Many of us feel that the term triple-negative really reflects our ignorance about the biology of this subset because we know there are positive features, features that we can target, that can potentially be used for therapies that will improve the outcome of this patient subset.
Beth Baughman DuPree, M.D., F.A.C.S. As a surgeon who has been in private practice for nearly 20 years, I have patients in my practice who still come back to see me on an annual basis, alive and well, without evidence of disease, having had triple-negative tumors. For many of these women, at the time of their diagnosis, these tumors did not seem to have a particularly ominous prognostic aspect. Ever since we developed the drug Herceptin that has singled out tumors that express the HER2 receptor, we have now moved on to the next category of tumors looking for targeted therapies. Because ER-positive tumors have had over 20 plus years of the benefit of anti-estrogen therapy such as tamoxifen with further advancements in medications such as the aromatase inhibitors, the tumors designated as triple-negative breast cancers have now become the tumors for which we want to identify a therapy that can specifically target them as we have done in ER-positive and HER2-positive patients. As recently as 10 years ago, patients with HER2-positive tumors were felt to have a more ominous prognosis. But in the short course of a decade, we have changed that aspect. Additionally, patients with triple-negative tumors are often the patients to whom now, as surgeons, we will offer neoadjuvant chemotherapy or chemotherapy prior to surgery in order to be able to downstage tumors and also begin systemic treatment as early as possible. We cannot change the biology of the tumor that is presented to us, but sometimes we can change the way in which we choose to approach the treatment of the tumor. It's unfortunate that this tumor subset gets its name because it doesn't express estrogen, progesterone, or the HER2 receptor and therefore in its name is the word "negative," inasmuch that carries a stigma of having something negative. As we move forward in clinical research, hopefully we will be able to find a targeted therapy that is equally effective on this subset of tumor so we can be in an online chat in a few years talking about a different subset or a different specific aspect of breast cancer that needs our attention.

On Wednesday, June 24, 2009, our Ask-the-Expert Online Conference was called Updates from the ASCO Annual Meeting. Nick Robert, M.D. and Beth Baughman Dupree, M.D., F.A.C.S. answered your questions about the newest findings on risk, screening, treatment, and more.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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