CANCER
FIFTEEN PER CENT OF PEOPLE WITH INVASIVE BREAST CANCER WILL HAVE TRIPLE-NEGATIVE BREAST CANCER. SP TAKES A CLOSER LOOK AT THIS FORM OF THE DISEASE....
TRIPLE-NEGATIVE BREAST CANCER: A GUIDE
B
reast cancer is the most common cancer in the UK, with 60,000 people diagnosed each year; 4,700 in Scotland.
Around fifteen per cent of those diagnosed with invasive breast cancer will have triple- negative breast cancer: a form of the disease, which has limited treatment options because it cannot be treated using targeted therapies available for other types of breast cancer.
Triple negative is the name given to breast cancer that is:
• oestrogen receptor negative (ER-)
• progesterone receptor negative (PR-)
• HER2 negative
Some breast cancers have receptors within the cell that bind to the hormone oestrogen. When oestrogen binds to these receptors, it can stimulate the cancer to grow.
All invasive breast cancers are tested for oestrogen receptors using tissue from a biopsy or surgery. Tests may also be done for progesterone (another hormone) receptors.
If breast cancer doesn’t have oestrogen receptors, it’s called oestrogen receptor negative (ER -). If it doesn’t have progesterone receptors, it’s called progesterone receptor negative (PR -).
HER2 is a type of protein found on the surface of cells. Some breast
28 - SCOTTISH PHARMACIST
cancer cells have a higher than normal amount of HER2 on their surface. This stimulates the breast cancer to grow.
All invasive breast cancers are tested for HER2 levels. If breast cancer cells have a normal level of HER2 on their surface, they’re known as HER2 negative (HER2-).
If a breast cancer doesn’t have oestrogen and progesterone receptors and is HER2 negative, it’s called triple- negative breast cancer.
Triple-negative breast cancers are often, though not always, high grade. Research has shown that the risk of triple negative breast cancer coming back is higher than some types of breast cancer in the first few years, but after five years the risks are similar to other types of breast cancer.
Some types of breast cancer are more likely to be triple-negative than others. These include medullary and metaplastic cancer. It’s also likely to be more common in:
• women who have inherited an altered BRCA gene (particularly BRCA1)
• black African–American women
• women who have not yet reached the menopause. GENETIC TESTING
All women under the age of 40 who are diagnosed with triple negative breast cancer should be offered a referral to a specialist genetics clinic
to discuss genetic testing, regardless of their family history of breast cancer. This is because women who have an altered BRCA1 gene are more likely to have triple negative breast cancer.
Women over the age of 40 may also be referred to a specialist genetics clinic to discuss genetic testing. If this is appropriate in your situation, your treatment team will discuss this with you.
TREATING TRIPLE NEGATIVE BREAST CANCER
Research into breast cancer is always going on across the UK and, in the past five years, newer treatments have helped to bring breast cancer survival rates to 85 per cent, with treatments such as hormone (endocrine) therapy and drugs such as trastuzumab (Herceptin) proving successful in attacking three important ‘biomarkers’ detectable in most strains of the disease.
These biomarkers are not, however, present in triple-negative breast cancers, meaning that older chemotherapy drugs are among the
few options available to such patients.
As such, triple-negative breast cancer is usually treated with a combination of surgery, radiotherapy, chemotherapy and bisphosphonates.
HOPE ON THE HORIZON?
New hope, however, appeared just last month when Irish scientists from University College Dublin, in conjunction with St Vincent’s University Hospital, announced that they may have found a way of treating this notoriously difficult to treat form of the disease.
Researchers from Breast-Predict – a research centre supported by the Irish Cancer Society - have shown that a new drug may hold the key to halting triple-negative breast cancer. The drug, named APR-246, works by preventing the growth of triple- negative breast cancer cells and by correcting a mutated p53 gene, which occurs in 80 per cent of triple-negative breast cancers. If it is successful in clinical trials, it has the potential to save patients’ lives. •
IF YOU HAVE PATIENTS SUFFERING FROM THIS TYPE OF THE DISEASE, THEN YOU COULD SIGNPOST THEM TO BREAST CANCER CARE’S ONLINE FORUM, WHICH HAS A SECTION FOR PEOPLE WITH TRIPLE-NEGATIVE BREAST CANCER. PATIENTS CAN POST MESSAGES AND RECEIVE SUPPORT FROM OTHER PEOPLE WITH TRIPLE NEGATIVE BREAST CANCER.
WWW.BREASTCANCERCARE.ORG.UK
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