- What is triple negative breast cancer?
- How old are the affected patients?
- What are the symptoms of triple negative breast cancer?
- What are its causes and risk factors?
- Why is an early diagnosis of this cancer important?
- Can triple negative breast cancer be cured?
- What are the treatments for triple negative breast cancer?
- What is the prognosis for triple negative breast cancer?
What is triple negative breast cancer?
THE triple negative breast cancers (TNBC) represent 10 to 15% of breast cancers. About 9,000 women are diagnosed each year in France with this type of cancer. in 40% of cases, they affect women under the age of 40. “They are characterized by an absence of three specific markers on tumor cells: estrogen receptors (ER-), progesterone receptors (RP-) and human epidermal growth factor 2 receptors (HER2)”, explains Afifa Lahrache, Medical Director Oncology of Gilead Laboratories. Normally, these receptors allow breast tissue cells to function properly.
How is it different from other types of breast cancer? “This feature makes this cancer is not eligible for hormonal treatments that target hormone receptors or anti-HER 2″ treatments, says Afifa Lahrache. It is also more aggressive: the recurrence rate is 30% in the 3 years following the announcement of the diagnosis.
How old are the affected patients?
“Triple negative breast cancer affects women on average younger than in other types of breast cancer”, explains the specialist. So the median age at diagnosis is 53i.e. 10 years earlier than for other types of breast cancer. “Patients can thus slip through the cracks of the organized screening strategy”, informs Afifa Lahrache.
This is why the diagnosis of triple negative breast cancer is often made incidentally, at a late stage. Finally, the other particularity of this breast cancer is the frequency recurrences within 3 to 5 years after initial treatment. “A third of women develop metastases in the first years following diagnosis. Beyond 5 years, recurrences are very rare and we can consider that women have little risk of recurrence”, she specifies. However, in the case of metastatic recurrence, life expectancy is limited.
What are the symptoms of triple negative breast cancer?
The symptoms are the same as breast cancer :
- Redness in the breast;
- Lump in the breast;
- Breast deformity;
- Inverted nipple;
- Ganglion in the armpit;
- Abnormal discharge from the nipple.
Nevertheless, the higher risk of metastasis : the tumor tends to grow faster and spread to other organs such as the liver or lungs.
What are its causes and risk factors?
THE triple negative breast cancer Has risk factors common to other breast cancers: smoking, alcohol consumption, obesity, physical inactivity. “There are also hormonal factors that are the same for all breast cancers, such as early periods, late menopause, late first pregnancy, very long menopausal hormone replacement therapy (over 10 years) and genetic factors since in 10% of cases or even a little more for triple negative cancers we find genetic predisposition factors and in particular the mutation of the BRCA gene”, teaches Gilead’s oncology medical director.
In other breast cancers, 5 to 10% of them are linked to the BRCA gene mutation. “When this mutation is known, there are screening, monitoring and surveillance programs”, says Afifa Lahrache. The prevalence of triple negative breast cancer is higher in African American and Hispanic women.
Why is an early diagnosis of this cancer important?
Triple-negative breast cancer has the particularity of being aggressive and rapidly progressing. “60% of women with this cancer diagnosed at a localized stage can be cured, but when this cancer is diagnosed at a metastatic stage, median overall survival is 14 months.“, informs Afifa Lahrache.
How can the diagnosis be early? THE symptoms are identical to other breast cancers: a mass or lump that appears in the breasts. “It is important to educate women to know their body well and to quickly consult their doctor or gynecologist if they notice an abnormality in their breasts, says Afifa Lahrache. This cancer is not widely known. she laments.
“Also young women under 40 do not necessarily feel concerned by breast cancer, she indicates. Young women must be informed of the value of self-examination and that they consult their gynecologist regularly”she recommends.
Can triple negative breast cancer be cured?
There are two possibilities in case of triple negative breast cancer:
- Cancer is at a localized stage (extension limited to the breast and adjacent lymph nodes in the armpit and above the collarbone): recovery is therefore possible;
- Cancer is at a metastatic stage : Healing is not possible. It is considered metastatic when other organs are affected: bones, lungs, liver, brain… Nevertheless, certain treatments exist to treat cancer and help people live longer with the disease.
Nevertheless, the recurrence rate is quite high: 30% within 3 years following the diagnosis. In case of early relapse, in 30% of cases, the therapies available have only limited effectiveness, according to the Gustave Roussy Institute. Nevertheless, according to new clinical trials, the 5-year survival without recurrence is 80%.
What are the treatments for triple negative breast cancer?
Until now, this type of breast cancer was treated with surgery, radiotherapy and chemotherapy. About half of triple-negative breast cancers respond well to chemotherapy, but the other half have disease resistance. In the absence of metastases, most triple-negative cancers are treated the same as other breast cancers.
In case of cancer linked to a mutation of the BRCA gene, PARP inhibitors (poly-ADPriboses-polymerase) are used.
Recently, scientific advances have allowed the arrival of new treatment options for triple negative breast cancer with new treatment options: immunotherapy (pembrolizumab) and conjugated antibodies. These new treatments represent additional weapons to treat this cancer.
A conjugated antibody (Sacituzumab Govitecan) was authorized by HAS in September 2021. Early access to this treatment for triple-negative metastatic breast cancer is authorized for people who have failed treatment after two or more lines of systemic treatment.) This is chemotherapy which, coupled with an antibody, allows to specifically target the tumour. Compared to conventional chemotherapy, this treatment provides a benefit in terms of progression-free survival with a median of 5.6 months versus 1.7 months with chemotherapy alone. It also provides a benefit in terms of overall survival with a median of 12.1 months compared to 6.7 months with chemotherapy alone and a 52% reduction in the risk of death(1).
What is the life expectancy for triple negative breast cancer?
Triple negative breast cancer is considered a poor prognosis cancer, with a higher likelihood of recurrences and metastases than other types of breast cancer. At the metastatic stage, 5-year survival is less than 20%.
(1) Bardia A, Hurvitz SA, Tolaney SM et al; ASCENT Clinical Trial Investigators. Sacituzumab Govitecan in Metastatic TripleNegative Breast Cancer. N Engl J Med. 2021 Apr 22;384(16):1529-1541.
Sources:
- Press release, Breast cancer: Emergency call for access to TRODELVY, a revolutionary treatment from the United States, Le Collectif #MobilisationTriplettes, April 2021.
- Gilead Press Release World Triple Negative Breast Cancer Day, 1er March 2022.