Triple Negative Breast Cancer Treatment

Triple-negative breast cancer cells do not have estrogen receptors, progesterone receptors or hormone epidermal growth factor receptor 2 (HER-2/neu). Essentially, a hormone receptor serves as a “lock” on the surface of a cell, which can be opened by a specific “key” hormone. When the hormone attaches to the receptor, it triggers a specific reaction to help the cell grow and reproduce.

Estrogen, progesterone and HER-2/neu are known to fuel the growth of hormone-positive breast cancer cells. However, these hormones do not promote the growth of triple-negative breast cancer cells because those cells lack the corresponding receptors.

For the same reason, triple-negative breast cancer does not respond favorably to hormone therapy and other breast cancer treatments that specifically target estrogen, progesterone or HER-2/neu. As a result, triple-negative breast cancer can be challenging to treat, although surgery, chemotherapy, radiation therapy and immunotherapy can be effective in many cases.

Surgery for triple-negative breast cancer

In many cases, surgery is the first-line treatment for triple-negative breast cancer. Many patients receive a combination of surgery and other treatments, such as radiation therapy, chemotherapy, immunotherapy or targeted therapy. The most commonly performed procedures are:

Lumpectomy

Also known as breast-conserving surgery, a lumpectomy involves the surgical removal of the tumor along with a slim margin of surrounding healthy tissue. The rest of the breast is preserved. After a lumpectomy, some patients receive radiation therapy to target any remaining cancer cells and reduce the risk of recurrence.

Mastectomy

Usually considered to address a large tumor or cancer found in multiple areas of a breast, a mastectomy involves the surgical removal of the entire breast. During the procedure, the surgeon may also perform a sentinel lymph node biopsy or axillary lymph node dissection to remove some nearby lymph nodes and assess the extent of cancer spread. After a mastectomy, some patients opt for breast reconstruction surgery to restore the appearance of the breast.

Chemotherapy for triple-negative breast cancer

A cornerstone treatment for triple-negative breast cancer, chemotherapy is a systemic treatment that involves the intravenous or oral administration of powerful medications that can destroy cancer cells or inhibit their growth. Chemo may be given:

• Before surgery to shrink the tumor and make it easier to remove
• After surgery to target any residual cancer cells and reduce the risk of recurrence

Triple-negative breast cancer often responds well to chemotherapy. A customized combination of drugs may be used to maximize treatment effectiveness.

Chemo is commonly associated with side effects, such as hair loss, nausea, fatigue and increased susceptibility to infection. Usually, any side effects can be managed with supportive care and will resolve after the treatment is completed.

Radiation therapy for triple-negative breast cancer

Often a key component of treatment for triple-negative breast cancer, radiation therapy is usually administered after surgery to destroy any remaining cancer cells and reduce the risk of local recurrence. During radiation therapy, high-energy X-rays or other forms of radiation are directed at the affected breast or chest wall, targeting the tumor bed and surrounding tissues. This can help eliminate any cancer cells that were not removed during surgery.

Radiation therapy is often given daily over several weeks. The dose and duration are precisely tailored to the patient’s specific circumstances. While generally well-tolerated, the treatment may cause temporary side effects, such as skin irritation and fatigue, which can usually be managed with supportive care.

Immunotherapy for triple-negative breast cancer

Immunotherapy is an emerging treatment option for some types of triple-negative breast cancer, particularly those with high levels of tumor-infiltrating lymphocytes (TILs) or programmed death-ligand 1 (PD-L1) expression. Immunotherapy works by stimulating the body’s immune system to recognize and attack cancer cells more effectively. One example involves the use of immune checkpoint inhibitors, which block proteins that inhibit the natural immune response, such as programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1). By blocking these proteins, immune checkpoint inhibitors can help the immune system target and destroy cancer cells.

While immunotherapy has shown promising results in some cases, not all patients will benefit. Currently, it is considered only for treating advanced or metastatic triple-negative breast cancer that has not responded to other treatments. In these cases, it may be used alone or in combination with chemotherapy or targeted therapy. Immunotherapy is associated with side effects such as fatigue, skin rash and inflammation, which can usually be managed with close monitoring and supportive care.

Targeted therapy for triple-negative breast cancer

Triple-negative breast cancer lacks expression of estrogen and progesterone receptors and human epidermal growth factor receptor 2 (HER2), which limits the use of certain hormone therapies and HER2-targeted therapies that are commonly used to treat other types of breast cancer. However, scientists are currently investigating other targeted therapies for triple-negative breast cancer, particularly those aimed at specific molecular pathways involved in cancer growth and progression.

One targeted therapy option for triple-negative breast cancer involves the use of poly (ADP-ribose) polymerase (PARP) inhibitors, which are drugs that target the DNA repair pathway. Tumors with mutations in the BRCA1 or BRCA2 gene are particularly sensitive to PARP inhibitors, as these mutations impair DNA repair mechanisms, making the cancer cells more vulnerable to DNA damage and cell death induced by PARP inhibition.

Another potential targeted therapy for triple-negative breast cancer involves the use of drugs that target specific signaling pathways or molecular targets implicated in cancer growth. For example, drugs that target the epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) or PI3K/AKT/mTOR pathway are being investigated in clinical trials.

Clinical trials for triple-negative breast cancer

Clinical trials for triple-negative breast cancer are vital for advancing treatment options and improving patient outcomes and quality of life. These critical studies allow researchers to explore new therapies, treatment combinations and strategies tailored specifically for triple-negative breast cancer, including chemotherapy, targeted therapy, immunotherapy and novel agents aimed at exploiting molecular vulnerabilities in the cancer cells. Clinical trials may also focus on identifying biomarkers for predicting treatment response, optimizing patient selection for specific therapies and understanding the underlying biology of triple-negative breast cancer to inform future treatment approaches.

By participating in a clinical trial, a patient may gain access to innovative treatments that are not yet widely available, as well as the opportunity to contribute to medical science and the development of more effective therapies for triple-negative breast cancer.

Benefit from world-class care at Moffitt Cancer Center

Moffitt’s renowned Don & Erika Wallace Comprehensive Breast Program is home to a multispecialty team that focuses exclusively on diagnosing and treating all types of breast cancer, including triple-negative breast cancer. In a single location, our patients can benefit from multiple expert opinions as well as comprehensive care from highly specialized medical oncologists, radiologists, fellowship-trained surgeons, radiation oncologists, plastic surgeons, nurses, social workers and other healthcare professionals.

As a National Cancer Institute-designated Comprehensive Cancer Center—the only one based in Florida—Moffitt is widely recognized as a leader in cancer research. We offer a robust clinical trials program through which our patients can be among the first to benefit from promising new treatments, and our researchers and clinicians are continually making discoveries that advance cancer science.

If you have questions about triple-negative breast cancer, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.