As soon as you’re diagnosed with any kind of breast cancer, one of your first questions might naturally be, OK, how do we treat this? If only there were a one-size-fits-all answer, but it’s pretty much the opposite: Breast cancer treatment can look really different for different people. And if it turns out you have triple negative breast cancer, treatment can become even more complex for your doctors—and confusing for you as the patient.
To hopefully make things a little easier to understand, we spoke to experts on the frontlines to find out what you really need to know about triple negative breast cancer treatment. While the best source of information about your individual case is always going to be your care team, consider this a resource for getting yourself oriented.
Why treating triple negative breast cancer is difficult
You may remember all of this information we’re about to share from your conversations with your doctors, but if not, here’s a quick reminder of what makes triple negative breast cancer different from other breast cancers.
There’s basically no end to the different ways to categorize breast cancer. One important method for classifying this disease is based on the types of receptors or proteins the cancer cells might have, which can affect how the cancer grows in your body, the American Cancer Society (ACS) explains.
Here’s how the Centers for Disease Control and Prevention (CDC) illustrates it: Cancer cells are like a house with receptors as different locks on the front door. If your cancer cells have any of these locks, your doctor can use certain keys called targeted therapies to help unlock the doors to the cancer cells and destroy them.
Breast cancer cells can have three kinds of receptors (or locks): One receptor is for the hormone estrogen, another is for the hormone progesterone, and the last is for an overgrowth of the protein human epidermal growth factor receptor 2 (HER2). Without any of these receptors, targeted treatments won’t work, which is why triple negative breast cancer is generally thought of as the most difficult subtype to treat, the National Cancer Institute (NCI) explains.
“The struggle we have with triple negative breast cancer is that we don’t have these targets or pathways into the cancer cells,” Rita Nanda, M.D., assistant professor of medicine and associate director of Breast Medical Oncology at UChicago Medicine, tells SELF.
But that doesn’t mean triple negative breast cancer is impossible to treat. Doctors have their ways, and many consider the future of treating this illness to be bright.
Treatment options in the earlier stages
Early-stage breast cancer is generally considered to be stages 0 through 3, Bora Lim, M.D., assistant professor in the Breast Medical Oncology department at The University of Texas MD Anderson Cancer Center, tells SELF. (Stage 3 is a bit of a special situation, since it’s not the latest stage of breast cancer but is technically somewhat advanced. In fact, it is often called locally advanced breast cancer, meaning it has spread into nearby tissues but not to distant body parts, according to the ACS.)
Because there are no approved targeted therapies available in the earlier stages of triple negative breast cancer, the standard of care is chemotherapy, according to the NCI. This is a systemic therapy, meaning it affects cells throughout your body, says Dr. Nanda, who specializes in the treatment of triple negative breast cancer along with early-onset, hereditary, and locally advanced breast cancers. It involves taking drugs orally, via injection, through infusion, or even topically. These drugs then travel throughout the bloodstream and destroy or halt the division of cancer cells. “The chemo that we use [for triple negative breast cancer] is the same regimen as for any type of breast cancer,” Dr. Nanda says.
Typically, you will receive chemo in combination with surgery (either a lumpectomy, which removes the tumor, or a mastectomy, which removes one or both breasts). Sometimes chemo comes after surgery, but your doctor might suggest doing it before, Wendy Y. Chen, M.D., M.P.H., breast oncologist at the Dana-Farber Cancer Institute and assistant professor of medicine, at Harvard Medical School, tells SELF. This helps shrink the tumor as much as possible before removing it, which has an added benefit: “The more knowledge about the treatment responsiveness of the tumor that someone has, the more we know about their prognosis,” Dr. Chen explains.
Your doctor may also recommend more chemo after the operation, Dr. Nanda says. While the success of chemotherapy always varies from person to person, the kind of surprising thing is that triple negative breast cancers are typically more sensitive to chemotherapy than tumors with hormone receptors or HER2 overexpression, according to the ACS. As Dr. Lim explains, there are various theories behind this, including that triple negative breast cancers mutate and grow so quickly that they’re more susceptible to the “weed killer” effect chemo can have on rapidly growing cells.
Treatment options in the advanced stages
Because triple negative breast cancer typically grows quickly, people often don’t realize they have it until it has metastasized to other parts of the body, the ACS says, at which point it is considered stage 4, or late-stage. Treatments like surgery, chemotherapy, and radiation are still an option for those with late-stage triple negative breast cancer. In addition, there are more novel treatments available for people in stages 3 and 4 of this disease, as a result of ongoing clinical trials.
A huge research focus right now is identifying the possible subtypes of triple negative breast cancer. There seem to be at least four, according to recent research, meaning that there could be multiple ways in for treatment.
“All these tumors get lumped together because of what they don’t have, not what they do have. So we’re trying to figure out what they do have so we can figure out different therapies,” Dr. Nanda explains. To go back to the CDC’s metaphor, researchers are still trying to find the locks on triple negative breast cancer tumors so that they can come up with the right keys. They’ve made several promising discoveries so far.
For instance, drugs known as PARP inhibitors may be an option for people with metastatic triple negative breast cancer who have mutations in the BRCA1 or BRCA2 genes, Dr. Lim says. (These genes increase the risk of getting breast and ovarian cancer.) Also used for those with metastatic estrogen receptor-positive and HER2-negative breast cancers, these drugs work by blocking a protein called PARP, which helps to repair DNA damage that happens during cell division, the NCI explains. (Sometimes the DNA damage repair process goes wrong, which can give rise to breast cancer.)
Researchers are also investigating whether PARP inhibitors may be effective in people without BRCA gene mutations, according to the NCI. Some newly identified triple negative breast cancer genes work similarly to BRCA1 and BRCA2 mutations, the ACS explains, so they may also respond well to PARP inhibitors.
There’s also a ton of interest surrounding systemic therapies like immunotherapy, which generally works by helping to stimulate the body’s immune system to fight cancer, says Dr. Lim. “Immunotherapy is starting to show some efficacy in specific types of advanced triple negative breast cancer,” sometimes in conjunction with other treatments, says Dr. Lim, who is the principal investigator on several triple negative breast cancer studies.
For instance, in March the Food and Drug Administration (FDA) granted accelerated approval to a breast cancer treatment regimen including immunotherapy. They approved a drug called atezolizumab in combination with chemotherapy for people with locally advanced or metastatic triple negative breast cancer whose tumors test positive for a kind of protein called PD-L1 and can’t be surgically removed. Other immunotherapy drugs are currently in clinical trials.
How to find clinical trials
In general, clinical trials are the best way to access therapies that are promising but not FDA-approved or are only approved for early stages of triple negative breast cancer, Dr. Chen explains.
“The hope is that we can take therapies that have been effective in late stages and move them up to be used in earlier stages,” Dr. Nanda says.
You might think clinical trials would only be available at large hospitals, possibly making them off limits to you. The great news is that these trials are becoming increasingly more available through community oncology groups across the country, Dr. Chen says. She points to the NCI Community Oncology Research Program (NCORP), a diverse national network of institutions whose goal is to bring cancer research studies and cancer care to communities of oncologists practicing at over 900 locations around the United States.
You can look into these trials on your own through various databases, like NCI and the National Institutes of Health (NIH). But navigating these sites and the highly specific eligibility criteria for trials can often be confusing, Dr. Nanda says. Plus, it can be time-consuming when you probably already have a lot on your plate. So, in general, Dr. Chen recommends first asking your oncologist if they know of any clinical trials that might be a fit for you and going from there.
Talking to your oncologist is also really smart because it can help you consider the benefits and drawbacks of clinical trials. (The ACS also has some great information to help guide your decision-making here.) For instance, not all of the drugs that get evaluated end up getting FDA approval, Dr. Chen points out. And while some trials will give you the current standard treatment in combination with the intervention they’re testing, in others, you will get just one or the other.
Treating triple negative breast cancer can be extremely challenging and at times disheartening, but experts do want you to know that there are good reasons to be hopeful. “We’re making new breakthroughs all the time in breast cancer treatment,” Dr. Nanda says. “There’s a lot of coming down the line.”