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Bhuvaneswari Ramaswamy MD, MRCP Professor and Section Chief- Breast Medical Oncology The Ohio State University Comprehensive Cancer Center.

What are the defining characteristics of triple-negative breast cancer?

Triple-negative breast cancers account for about 15 percent of all breast cancers and are defined as breast cancers that are estrogen receptor– and progesterone receptor–negative, meaning that these cancers do not depend on estrogen for their growth. In addition, the HER2/neu gene is not amplified in these cancers (when amplified, HER2/neu produces a protein called HER2 that acts as an accelerator for growth when present in an abundance in cancer cells).

What are the risk factors for triple-negative breast cancer?

There are no modifiable risk factors for triple-negative breast cancer. These cancers tend to occur more frequently in young premenopausal women, in African-American women, and in women who carry the abnormal inherited breast cancer susceptibility gene BRCA1.

Why is triple-negative breast cancer such a challenge to treat?

In general, these tumors are more aggressive and grow at a rapid rate. There are two major challenges in treating these tumors. First, because they have no known targets (such as estrogen receptor or HER2/neu), currently the only way to treat them is to use chemotherapy, which generally results in more side effects. Second, even when we treat these tumors with chemotherapy, they may or may not respond; and even when they do, response this is often short-lived.

Are there specific questions that women should ask their healthcare team when they are diagnosed with triple-negative breast cancer?

The key question a woman who is diagnosed with triple-negative breast cancer should ask is whether an appropriate clinical trial exists for her diagnosis. There are some novel approaches to treating these cancers that are still in investigational stages but which hold great promise. It is important that patients make use of these opportunities when possible to increase their treatment options. In addition, patients should be sure to consult their healthcare team to see if genetic testing should be a consideration.

What has been the standard protocol for treating triple-negative breast cancer, and what treatments or innovations are on the horizon for this difficult-to-treat disease?

The standard protocol to treat early-stage triple-negative breast cancer confined to the breast and the axillary lymph nodes is chemotherapy and surgery. Often chemotherapy is administered before the surgery. At present there are no further treatment options for early-stage triple-negative breast cancer beyond close follow-up care with regular physical exams and mammograms.

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There are innovative approaches currently under study, however, including the addition of targeted therapy to a chemotherapy backbone.

For advanced triple-negative breast cancer, the current standard approach has been to treat with various chemotherapy regimens. Recent breakthroughs in the treatment of TNBNC include, Immunotherpy, PARP inhibitors and Trodelvy. Poly (ADP-ribose) polymerase (PARP) is an enzyme that is required for cells to repair the DNA damage induced by any form of injury (including radiation, UV rays, and chemotherapy). Unfortunately, the cancer cells also use this enzyme to correct the damage induced by chemotherapy, making that treatment less effective.

Several clinical trials are currently ongoing at various centers, using newer precision cancer medicines alone or in combination with chemotherapy in triple-negative and genetically inherited breast cancers. Women just discuss clinical trail options with their treating physician.

For more information about triple-negative breast cancer clinical trials at The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, contact the Jamesline at (800) 293-5066.

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The Ask The Expert Series is made possible by support from The Personalized Medicine Foundation, CancerConnect and the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The Ohio State University. The "Ask The Expert" series is not medical advice nor is it a substitute for your doctor. It should serve as a guide to facilitate access to additional information and enhancement of a shared decision making process with your treating physician.