Several treatment options exist for triple negative breast neoplasms, including cytotoxic chemotherapy, hormone therapy, and chemotherapy with trastuzumab. Treating the cancer early through the use of cytotoxic or hormone therapy can help patients prevent symptoms and improve survival. Patients should consider enrolling in clinical trials to explore new treatments like trastuzumab (Herceptin).
TNBCs usually appear as solid masses with a palpable and movable axillary nodule. Axillary enlargement and/or the presence of lymphovascular invasion or peritumoral lymphoplasmatic stroma might be present. Imaging studies are helpful to the radiologists to provide an overall picture which facilitates the diagnosis. Radiologists need to be aware of such lesions since they respond well to hormonal therapy.
The lack of evidence of curative treatment for triple negative breast cancers in this population means that patients with TNBC are never going to be cured of their condition. Therefore, it is important that TNBC patients receive the best evidence based treatment for their tumours.
Every 3 years, around 469,100 new cases of TNBC occur in Americans. The increased prevalence of triple negative breast cancer in African-American women is not restricted to high-risk subgroups as previously acknowledged.
TNBCs are rare and most patients may not be diagnosed to this rare sub-type. The combination of morphological and molecular subtypes is important to improve management and patient outcomes. These patients should be treated according to NACTG recommendations for their disease, in order to achieve higher likelihood for a cure and better overall outcomes. The NACTG would be the best recommendation to evaluate and recommend in patients with TNBC and who is <30 years of age. Clinicians with more experience in treating TNBC and breast cancer patients should be consulted in selecting appropriate patients to participate in clinical trials. Finally, all the available drugs have been proven effective in TNBC patients and tailored for personalized treatment in future.
Only 1 of the 42 patients on study had a significant clinical response. Most common was reversible stomatitis in 19 cases (42%). Dysgeusia (the unpleasant taste in the mouth) was reported by 34 patients (80%), predominantly in the first 3 on trial days. Other less common (>10% incidence) but serious clinical adverse events included fatigue (11 patients; 26%) and myelosuppression (4 patients; 10%).
As the efficacy of onalespib in triple-negative breast cancer has been proved, the use of this agent in this clinical setting needs to be further expanded. This retrospective study suggests that the presence of the ALK or mam-A or NTRK2 amplifications is of importance for selecting patients who may benefit from onalespib therapy. A more precise selection of patients for targeted therapies can be achieved by detecting these molecular alterations prior to treatment.
There is increasing interest in the treatment of triple negative breast neoplasms, and current trials show that patients with triple negative breast neoplasms can benefit from targeted therapy.
As of the end of 2017, the RECIST v2.0 guideline has been updated, no longer requiring that the following be reported as interim findings: a 30% difference and a p-value, or better, at one year, or at three years; or 10% difference in p-value at two years, or better, without a p-value. Onalespib demonstrates higher rates of complete and overall response and more complete response rates at three and five years than a placebo in postmenopausal patients with platinum-resistant metastatic triple-negative breast cancer who have received two prior lines of chemotherapy.
Onalespib achieves a greater objective activity than placebo, without increasing rates of severe adverse events when compared to placebo, and is a promising drug for further investigation.
Although it is effective, the clinical use of afatinib or NS398 is associated with higher rates of sensory and motor deficits compared with erlotinib and/or docetaxel. In an effort to improve the tolerability of current tyrosine kinase inhibitor therapies, efforts to improve molecular and cellular mechanisms of cancer progression, and reduce EGFR-driven drug resistance as a result of increased targeting of additional pathways has become an active focus of current research. Ataluren has been proposed as a potential adjuvant therapy for triple-negative breast cancer with an unfavorable prognosis due to the lack of EGFR and ER signaling blockade, as well as AKT/GSK-3β and MAPK/ERK pathways inhibition.