Of the one million new breast cancer patients diagnosed each year worldwide, approximately 170,000 of these cases are triple negative.
The term applies to patients who do not express the hormone receptors for estrogen or progesterone and are also HER2 negative. About 75% of these patients are of the basal type and the diagnosis is more common in young woman and the black population. Triple negative breast cancer is a distinct subtype of breast cancer and requires its own unique approaches.
Case: Triple Negative Breast Cancer
In August of 2017, I met a delightful 50-year-old British woman who had traveled to California from her home in Saratoga Springs, Utah. The patient was seen by her local physician for palpable mass in the right breast. A biopsy confirmed high grade triple-negative breast cancer. Staging identified eight positive axillary lymph nodes.
The patient was referred to a prestigious research center and obtained an opinion from a breast cancer oncologist. Despite the high-grade disease, high risk presentation, and triple negative finding, she was offered the standard chemotherapy combination of Cytoxan/Adriamycin followed by Taxol.
As a young woman and mother of six children, this patient had no intention of taking "off the shelf therapy." She drove the many hours from Utah to California for an opinion.
I referred the patient to one of my skilled surgeons who conducted a biopsy in August and the tissue was evaluated in our laboratory.
Her Functional Profiling Results
The results were striking. Every platinum-based regimen killed virtually every cell. The other more standard regimens were less effective.
I suggested to the patient that a modification in the pre-operative (neoadjuvant) chemotherapy regimen would be warranted. In the interim, the patient was evaluated at the molecular level and found positive for the BRCA1 mutation.
At this point, everything fit together, the triple negative finding, the exquisite sensitivity to Cisplatin-based therapies, and the BRCA1 mutation are all “peas in a pod” for triple negative breast cancer. It was evident that a platinum-based regimen was essential.
With the recent memory of her interaction with the cancer center physician, the patient made a decision. She was going to commute to California for care.
In August, we began Carboplatin-based therapy and the tumor disappeared. Within two cycles, the large tumor and axillary nodes were gone.
Several cycles later, they were undetectable by radiographic means. With PET scan confirming a complete remission, and the BRCA1 mutation identified, the patient underwent bilateral mastectomies and was referred for future evaluation and prophylactic hysterectomy with oophorectomy.
Complete Remission Achieved
Now two years since diagnosis, the patient is in complete remission and having undergone the necessary surgical procedure to address any additional risks associated with the BRCA1 mutation is now living a normal life.
Her story is the subject of a recent breast cancer blog posting and serves as an interesting example of patients following their instincts as they seek the best possible and potentially curative therapy for their own individual cancers.
Although the patient was sensitive to several forms of chemotherapy and might have benefited from standard treatment, the therapies that she received were exactly right for her and provided immediate benefit with the least toxicity. Adriamycin-based treatments, widely used in this disease, are both less active than the platin and demonstrably more toxic.
We are delighted that the patient received exactly the right treatment for her, that she tolerated it well, and she gives us a call occasionally on her way from a soccer game or band practice with her six children in the car – a victory for intelligent cancer therapy.
As always, I appreciate your thoughts and comments.
Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He is a TEDx speaker, author of the book Outliving Cancer, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California. For more info go to NagourneyCancerInstitute.com