Initial Diagnosis of Triple-Negative Breast Cancer

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EP: 1.Initial Diagnosis of Triple-Negative Breast Cancer

EP: 2.Neoadjuvant Chemotherapy for TNBC

EP: 3.Surgical Options for Triple-Negative Breast Cancer

EP: 4.Active Surveillance for Disease Progression in TNBC

EP: 5.Considerations for Referral After Progression of TNBC

EP: 6.The ASCENT 3 Trial of Sacituzumab Govitecan for TNBC

EP: 7.Safety and Efficacy of Sacituzumab Govitecan

EP: 8.Social Support Systems for Patients With TNBC

EP: 9.Advice for Future Patients and Caregivers in TNBC

Aditya Bardia, M.D., MPH: Hello, and welcome to CURE Expert Connections®. I’m Dr. Aditya Bardia. I would like to welcome one of my patients, Latasha, to share the story of her journey with triple-negative breast cancer. Welcome, Latasha.

Latasha Jordan: Thank you. My name is Latasha Jordan, and I have triple-negative breast cancer.

Aditya Bardia, M.D., MPH: The term triple negative was developed in the 2000 era—2005, 2006. In part, this term was developed because of advances in the other settings. We had hormonal therapy for hormone receptor-positive breast cancer, and we had the drug trastuzumab for HER2 [human epidermal growth factor receptor 2]-negative breast cancer. It was important to identify these two targets, because there were targeted therapies against these targets.

Tumors that did not express these two targets were called triple negative. These were tumors that do not express ER [estrogen receptor], PR [progesterone receptor], or HER2. This was kind of a diagnosis of exclusion.

From a biology perspective, it’s a tumor that is associated with a more aggressive biology, a higher risk of recurrence. Because it does not have an actionable target, the standard of care has traditionally been chemotherapy.

If we talk about risk of recurrence, it depends on the stage of the tumor. For patients with stage 2 or stage 3 triple-negative breast cancer, there’s a higher risk of recurrence. In the metastatic setting, again, the mainstay has been chemotherapy. Here, the overall survival was in the range of a year to a year and a half in the past. But now because of advances in immunotherapy and advances in antibody-drug conjugate therapy, overall survival has improved.

For example, the ASCENT trial that evaluated sacituzumab govitecan [Trodelvy] compared to standard chemotherapy showed a doubling of overall survival with sacituzumab govitecan, or the antibody-drug conjugate. Similarly with immunotherapy, we’ve seen an improvement in overall survival compared to chemotherapy alone. The outlook looks much better compared to what it was 15 years ago.

Latasha, walk us through your initial signs of disease that led to the diagnosis of triple-negative breast cancer.

Latasha Jordan: In May of 2018, I went to for my physical examination. In June, I was taking a shower and I saw a lump on the side of my left breast. I took it as if it was a cyst; I didn’t really take it seriously. I never called the doctor. I was going on a trip. I was going on a lady’s trip; I went on that trip. Then, I went on another trip; I went to New York. In October, it started hurting. In November, it got worse. It got to the point where I couldn’t even take it anymore. So, I called my doctor. She scheduled an appointment. I called her at the end of November, and I went in to see her in December.

When I went in, she checked the lump. She made an appointment for me for my mammogram. Mind you, she’d been asking me to take a mammogram for years. I will not lie to you, I never wanted to get a mammogram but I had to. The mammogram was scheduled for January. I was with my mom when I went for the mammogram.

Then I think the next step was I had to take a biopsy. I did that. All of this occurred in January. The next step was for me to speak with the doctors. My mom and I sat down in a room. I was told that I had breast cancer. The doctor was so kind. He looked me straight in my face, held my hands, and that’s how he told me. He was so kind that my reaction was, “Is this real? This can’t be real. Please let this be a dream.” All I thought about was my son. I thought I was going to die.

Then he called a doctor who was on vacation. She came in on her vacation to sit and talk to me. I thought that was beautiful. It calmed me; it made me feel so much better.

This journey has been so long. After that, I had to get all of these different scans. Then in February, I got my port put in. After the port, I started my infusions. They explained everything to me, step by step.

I asked about my hair. She explained that sometimes your hair will fall out after the first treatment, but definitely by the second treatment. And by the second treatment, it did. That’s when it started falling out.

I didn’t think any of these things would affect me. The thing that affected me the most was my hair. I don’t know if that sounds vain, but that’s what affected me. When I went to a hair store to get my first wig, I cried in the hair store.

Aditya Bardia, M.D., MPH: Latasha, what you’re describing is something that other patients have mentioned as well. Thank you for candidly sharing your experience of the diagnosis and what you’ve been through.

Triple-negative breast cancer is a subtype of breast cancer essentially defined as tumors that do not express the estrogen, progesterone, or HER2 receptors. This is about 15% to 20% of all breast cancers. The unique feature about triple-negative breast cancer is that it tends to affect younger women. It tends to affect African Americans. Compared to other subtypes, it has a more aggressive course. This is in part because of a lack of targeted therapies for this subtype of breast cancer.

The diagnostic work-up you had, Latasha, was exactly what we would recommend for triple-negative breast cancer—a mammogram, ultrasound, and biopsy. If something is seen, then it is evaluated under the microscope to confirm triple-negative breast cancer status.

Breast cancer can be diagnosed based on screening. It’s recommended that patients have screening mammograms. Often during screening, there’s an abnormality that can be detected. If you see an abnormality, that needs to be worked up further with an ultrasound and a biopsy.

The second scenario occurs when a patient notices a lump on their breast. If that’s the case, the provider usually does a physical examination. If the provider confirms that the lump is present, additional evaluation is done with a mammogram and an ultrasound. A biopsy of the lump is usually taken as well. The biopsy gets evaluated by the pathologist, who evaluates things under the microscope to see if there are any cancer cells present. If there are breast cancer cells present, we do additional staining to look at these targets—ER, PR and HER2. If the tumor has ER/PR, it’s called a hormone receptor-positive tumor. If the tumor has presence of HER2, it’s called HER2 positive. If none of these are present, it’s called triple-negative breast cancer.

Transcript edited for clarity.