Treatment of Triple-negative Breast Cancer

Triple-negative breast cancers (TNBC) don’t have estrogen or progesterone receptors and also don’t make too much of the HER2 protein. Because the cancer cells lack these proteins, treatment options for triple-negative breast cancer are limited. Hormone therapy and drugs that target HER2 are not helpful, so chemotherapy is the main systemic treatment option. And although, TNBC tends to respond well to initial chemotherapy, it tends to come back (recur) more frequently than other breast cancers.

Stages I-III Triple-negative Breast Cancer

If the early-stage TNBC tumor is small enough for surgery then breast-conserving surgery or a mastectomy with a check of the lymph nodes may be done. In certain cases, such as a large tumor or if lymph nodes are found to have cancer, radiation may follow surgery.

Because hormone therapy and HER2 drugs are not choices for women with triple-negative breast cancer, chemotherapy is the main systemic option. It might be given before surgery (neoadjuvant chemotherapy) to shrink a large tumor. If residual (left behind) cancer is found after neoadjuvant chemotherapy has been given, your doctor may recommend you take an oral chemo drug called capecitabine for 18 to 24 weeks. You might also be given chemo after surgery (adjuvant chemotherapy) to reduce the chances of the cancer coming back.  

Stage IV Triple-negative Breast cancer

Chemo is often used first when the cancer has spread to other parts of the body (stage IV). Common chemo drugs used are anthracyclines, taxanes, capecitabine, gemcitabine, eribulin and others. 

For women with TNBC who have a BRCA mutation and whose cancer no longer responds to common breast cancer chemo drugs, other chemotherapy drugs, called platinum drugs (like cisplatin or carboplatin) or the targeted PARP inhibitors, olaparib (Lynparza) and talazoparib (Talzenna) may be considered.

Advanced TNBC that makes the PD-L1 protein may be treated first with the immunotherapy drug atezolizumab along with Abraxane (albumin-bound paclitaxel). The PD-L1 protein is found in about 20% of TNBC.

Surgery and radiation may also be options in certain situations.  See Treatment of Stage IV (Advanced) Breast Cancer for more information.

Regardless of the stage of the cancer, participation in a clinical trial of new treatments for TNBC is also a good option because TNBC is rare, tends to have a poor prognosis (outcome) compared to other types of breast cancer, and because these studies often allow patients to have access to drugs not available for standard treatment.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: September 18, 2019 Last Revised: September 18, 2019

 

 

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