Triple-Negative Breast Cancer

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Francine Walters
5 years ago
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1 Triple-Negative Breast Cancer Payal D. Shah, MD Basser Center for BRCA Abramson Cancer Center University of Pennsylvania October 13, 2017

2 Outline What is triple-negative breast cancer? Treatment updates Stages II-III TNBC Stage IV TNBC Progress where we are in 2017! 2

3 TRIPLE-NEGATIVE BREAST CANCER (TNBC): WHAT IS IT? 3

4 TRIPLE NEGATIVE BREAST CANCER TRIPLE-NEGATIVE CANCER About 15-20% of breast cancers are triplenegative Do not use hormones (Estrogen, progesterone) to grow Do not rely on HER2 protein to grow Chemotherapy is a mainstay of treatment 4

5 TNBC TREATMENT UPDATES FOR PTS WITH STAGES II-III 5

6 Chemotherapy before surgery for TNBC Chemo either before OR after surgery is ok it depends on the patient Chemo before surgery = Neoadjuvant The goal of giving chemotherapy first is for chemo to kill the cancer so none is found at the time of surgery Having no cancer left at the time of surgery is associated with better outcomes 6

7 Chemotherapy before surgery for TNBC Two recent chemotherapy advances: (1) Carboplatin with paclitaxel (taxol) adds benefit Also adds side effects, so not for everyone (2) If chemo did not make the cancer entirely disappear at the time of surgery, capecitabine (Xeloda, oral chemo) can be given after surgery and improves survival 7

8 Chemotherapy before surgery for TNBC Adding immunotherapy to chemotherapy before surgery looks promising! 8

9 Chemotherapy before surgery for TNBC Adding immunotherapy to chemotherapy before surgery looks promising! I-SPY2 national trial ongoing at Penn (PI: Clark) 9

10 Chemotherapy before surgery for TNBC Adding immunotherapy to chemotherapy before surgery looks promising! I-SPY2 national trial ongoing at Penn (PI: Clark) In patients with TNBC, when pembrolizumab (Keytruda, immunotherapy) was added to chemotherapy, 60% of patients had no cancer left at the time of surgery, as compared with 20% of patients who received only chemotherapy! 10

11 Chemotherapy before surgery for TNBC Adding immunotherapy to chemotherapy before surgery looks promising! I-SPY2 national trial ongoing at Penn (PI: Clark) In patients with TNBC, when pembrolizumab (Keytruda, immunotherapy) was added to chemotherapy, 60% of patients had no cancer left at the time of surgery, as compared with 20% of patients who received only chemotherapy! I-SPY2 now modified to include the pembrolizumab throughout all of the chemotherapy cycles, instead of just half 11

12 STAGE IV TNBC: TREATMENT UPDATES 12

13 Immunotherapy for Stage IV TNBC LOTS of clinical trials Some are combining immunotherapy with chemotherapy Soon to open at Penn: carboplatin with atezolizumab Some are looking at newer types of immunotherapy Currently open at Penn: CAR-T trial 13

14 PARP inhibitor effective for TNBC in patients with BRCA1/2 mutations Targeted therapy, not chemotherapy Taken by mouth More effective and better quality of life for patients than chemo Pending approval More on this this afternoon from Dr. Susan Domchek 14

15 TNBC IN

16 Making progress with your help! Chemotherapy before surgery: Carboplatin Capecitabine Pembrolizumab Patients with Stage IV Triple-Negative Cancer Chemotherapy + immunotherapy trials CAR-T therapy trials Olaparib for BRCA1/2-associated TNBC 16

17 Making progress with your help! Chemotherapy before surgery: Carboplatin (2014, 2015) Capecitabine (2017) Pembrolizumab (ongoing now) Patients with Stage IV Triple-Negative Cancer Chemotherapy + immunotherapy trials (ongoing now) CAR-T therapy trials (ongoing now) Olaparib for BRCA1/2-associated TNBC (2017) 17

18 Making progress with your help! Chemotherapy before surgery: Carboplatin (2014, 2015) Capecitabine (2017) Pembrolizumab (ongoing now) Patients with Stage IV Triple-Negative Cancer Chemotherapy + immunotherapy trials (ongoing now) CAR-T therapy trials (ongoing now) Olaparib for BRCA1/2-associated TNBC (2017) We are hopeful 18

19 Making progress with your help! Chemotherapy before surgery: Carboplatin (2014, 2015) Capecitabine (2017) Pembrolizumab (ongoing now) Patients with Stage IV Triple-Negative Cancer Chemotherapy + immunotherapy trials (ongoing now) CAR-T therapy trials (ongoing now) Olaparib for BRCA1/2-associated TNBC (2017) We are hopeful Thank you for participating in clinical trials! 19

20 THANK YOU! 20

21 TRIPLE NEGATIVE BREAST CANCER TRIPLE- NEGATIVE CANCER We are now learning that there are many different subtypes of triple negative breast cancer. TRIPLE- NEGATIVE CANCER TRIPLE- NEGATIVE CANCER This is starting to change how we think about future treatments TRIPLE- NEGATIVE CANCER TRIPLE- NEGATIVE CANCER 21

22 What you can do for yourself Be proactive (you re doing it already!) Ask about clinical trials Stay healthy (balanced diet and exercise as able) Seek out support emotional & physical Yoga, exercise, creative writing, art therapy, Reiki, Mindfulness, acupuncture, massage, aromatherapy Some are for patients as well as caregivers Laura Galindez, MSW, LSW, Integrative Oncology Patient Navigator

23 *Pembrolizumab FDA Approved for some triple negative breast (and other) cancers Approved for any incurable cancer without a good tx alternative AND a specific tumor genetic finding Probably applies to very few patients with TNBC 23

Highlights from the 2009 Annual Meeting of the American Society of Clinical Oncology

BREAST CANCER 24 Breast Cancer Highlights from the 2009 Annual Meeting of the American Society of Clinical Oncology Edited by William J. Gradishar, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern