Triple Negative Breast Cancer: Making Sense of Estrogen, Progesterone and HER2 Receptor Status
Most oncologists now are thinking of breast cancer as at least four diseases based on endocrine features - luminal A, luminal B, Her2 positive and the so called "triple negative" - breast cancers that express neither estrogen receptors, progesterone receptors nor Her2 receptors. These latter breast cancers, or "triple negative" breast cancers have a reputation (deservedly so) for being difficult to treat.
Yet many oncologists, like myself, have dozens of patients with "triple negative" breast cancer who are cured. And many who are not. What is the difference?
Well the therapeutic armamentarium is not as great with a triple negative breast cancer. Hormonal therapy (tamoxifen, aromatase inhibitors) does not work. The benefit we see with Herceptin (and a newer agent Tykerb) in combination with chemotherapy, is not available in either the curative (newly diagnosed) or metastatic setting.
And yet many women are cured. There was a recent article in one of our oncology journals that I read; it was the fifth out of five articles that issue and not a high profile article, but it reinforced thinking about triple negative breast cancer.
This was a study of many patients treated at MD Anderson Cancer Center in Houston with triple negative breast cancer. At this cancer center many women receive chemotherapy before surgery, or neoadjuvant chemotherapy, and thus the tumor can be examined to see what sort of response the cancer had to chemotherapy.
The results? Those women whose cancers shrank from chemotherapy had a higher chance of cure than those women who didn't. Another finding which was probably confirmed, rather than new, was that those women who developed metastatic disease with triple negative breast cancer were more likely to develop metastases to internal organs (like the liver and lung) rather than the bone. And a third finding was that many women whose cancer did recur had a recurrence within the first three years after diagnosis.
What is the take home message for our readers? I think the main message should be to keep fighting and to never lose hope - even though triple negative breast cancer is a tougher cancer to treat, if it responds nicely to chemotherapy then a survival advantage - and a good cure rate - will be seen.
We don't have a way of "looking" for that response in the traditional adjuvant setting - chemotherapy given after surgery - so maybe it's best to assume that we are curing each patient with triple negative breast cancer for starters. And we continue to look for better chemotherapy agents and better ways of determining which agents are right, so that we can cure even more patients with triple negative breast cancer.