Il triple negative breast cancer it is a rather aggressive type of breast cancer. It accounts for 15% of the 55,000 cases of breast cancer and, according to the report “The numbers of cancer in Italy 2021”every year in Italy they register 8,000 new cases.
What is triple negative breast cancer
It’s about one of the more aggressive forms and difficult to cure. It means that it tends more than others to spread quickly (therefore to become metastatic) and to recur after the end of the treatments. The term “triple negative” means that on cancer cells are three receptors are absent: that of estrogen (ER), that of progesterone (PR) and that for human epidermal growth factor (HER2). And since all three are molecular targets against which there are targeted treatments, it is a tumor for which it is not possible to use these therapies, very effective and minimally invasivewhich instead are used against other types of breast cancer.
Incorrect life habits, such as a sedentary lifestyle, alcohol, smoking, obesity, a diet rich in fat and low in vegetables, are all risk factors that expose you to the onset of breast cancer. However, you can intervene on them by changing your lifestyle in a healthier way. Between risk factors not modifiableInstead, there are:
- age under 50;
- familiarity with breast cancer (personal or family);
- presence of genetic mutationsespecially BRCA1.
Triple negative breast cancer: symptoms
Similar to other forms of breast cancer, triple negative can also manifest with some of these symptoms:
- appearance of palpable nodules o visible on the udder;
- change in the shape of the nipple (in out or in);
- change in the appearance of breast (asymmetries) and of the breast skin (orange peel in places);
- secretions give one nipple (if the losses are from both nipples the reasons could instead be hormonal);
- enlargement of lymph nodes underarms.
There are two types of prevention: primary and secondary. There primary prevention pertains to modifiable risk factors. Means that lead a healthy life, adopting healthy behaviors and habits, lowers the chances of having breast cancer. Some examples: eat lots of fruit and vegetables, fiber, good fats, stop or not start smoking, drink alcohol as recommended, do physical activity, keep your weight under control by avoiding overweight or obesity. There secondary preventionon the other hand, has to do with the exams Of screening and those aimed at early diagnosis.
There is a national screening program to detect all types of breast cancer early. This program gives the possibility, to all women between the ages of 50 and 69to execute every two years a free mammogram. In some Italian regions, screening has been extended to two other age groups: between 45 and 49 years on an annual basis; and between 70 and 74 years old every two years. Mammography is an examination during which the breast is pressed between two plates in order to undergo an X-ray. It allows you to see the presence of any tumor formations. In general, for women with familiarity or with particular characteristics of the breast, mammography is prescribed before the age of 50 by their doctor or gynecologist (in this case, however, we are not talking about screening, but about diagnostic tests prescribed ad hoc).
In case of the appearance of nodules or any of the symptoms described abovebreast cancer can be detected early with aultrasound. It is a useful test especially for examining young breasts. It must be prescribed by your doctor.
When personal history reveals information that puts a woman at increased risk of breast cancer, such as the possible presence of inherited genetic mutations, the doctor may consider performing genetic tests for the analysis of the BRCA 1 and 2 genes. If this review is successful, prior checking measures can be strengthened, for example by undergoing a MRI able to identify the tumor very early, or – and it is the famous case of actress Angelina Jolie – resort to mastectomy preventivethen to surgical removal of the breast.
How to treat triple negative breast cancer
As with many other breast cancers, even for the triple negative one the surgery it is undoubtedly a mainstay of treatment. It can be of two types: conservative and invasive. The first is called quadrantectomiaconsists in the removal of only the area of the breast where the tumor is located, and its diffusion, from the eighties onwards, is due to the intuition of Umberto Veronesi.
The second, the mastectomypredicts instead the removal of the whole gland mammary. For triple-negative tumours, however, the procedure is often also performed removal of axillary lymph nodesif signs of the disease have been identified by analyzing the sentinel lymph nodes (the first to be reached by cancer cells).
The only therapeutic option for patients with triple negative cancer until recently was the chemotherapy. Today it still plays an extremely important role after surgery, but it presents important therapeutic limitations. In many cases, in fact, it fails to eliminate potential residual tumor cells after surgery, and is only partially able to prevent the appearance of recurrences or metastases.
«After the surgical phase, chemotherapy remains a priority for triple-negative breast cancer,” he explains Alessandra Fabi, head of UOSD Precision Medicine in Senology, Agostino Gemelli IRCCS University Hospital Foundation in Rome. «But to it today they can be associated with immunotherapy e targeted drug treatments based on the genetic mutations that characterize the different forms».
Immunotherapy and targeted drugs
Among the new therapeutic weapons available to doctors for the treatment of triple negative breast cancer there are immunotherapy they Parp inhibitors. In the first case, these are medicines, i.e. molecules, capable of stimulating a response of the immune system against tumor cells.
Recently, in the scientific journal New England Journal of Medicineone has been published study on the efficacy of an immunotherapeutic moleculefrom the name pembrolizumab. The study, which had the objective of evaluating the use of pembrolizumab in addition to standard therapy with chemotherapy, yielded excellent results. In fact, the combination has been shown to be extremely effective, compared to chemotherapy alone, in prolonging overall survival from the disease.
In the second case, however, we speak of targeted drugs able to target tumor cells selectively. They are used in the presence of mutations of the BRCA 1 and 2 genes. For some years now, the Italian Medicines Agency (Aifa) has approved the use in clinical practice of taking, a molecule belonging to this category. In the trials conducted, its use resulted in a significant improvement in survival.
A new medicine
Additional treatment opportunities for patients with advanced triple-negative breast cancer may come from another class of medicines: drug conjugated antibodies. In particular, as was presented at the last congress of the American Society of Clinical Oncology (Asco), dal sacituzumab govitecan, recently approved by US and European regulatory agencies.
It is a medicine that combines the potential of chemotherapy to those of monoclonal antibodies. In fact, it is able to deposit the chemotherapy molecule directly inside the diseased cell, killing it. Today the molecule sacituzumab govitecan is approved in over 40 countries for the treatment of adult patients with unresectable, locally advanced or metastatic triple-negative breast cancer who have already received two or more prior systemic therapies, at least one of which was for metastatic disease.
Life expectancy with triple negative breast cancer
Triple negative is a particularly aggressive form of breast cancer. And for this it presents a average survival from the diagnosis lower than the other forms. However, recalls the expert of the Polyclinic of Rome, «le resources made available by the research science have allowed in the last period, and will allow in the future, to significantly improve survival after diagnosis”.