Triple-negative metastatic breast cancer

In metastaticinfo-icon breast cancer, or stageinfo-icon IV disease, the cancer cells have traveled from the breast and nearby lymphinfo-icon nodes and formed tumors in tissues or organs far away from the breast. Metastatic breast cancer can be:

  • Hormone receptorinfo-icon-positive
  • HER2-positive
  • Both hormone receptor-positive and HER2-positive
  • Triple-negative

If you are diagnosed with metastatic triple-negative breast cancerinfo-icon, or TNBC, it means the stage IV breast cancerinfo-icon is not hormoneinfo-icon-sensitive and does not have high levels of the HER2 proteininfo-icon. Triple-negative breast cancer can be treated with chemotherapyinfo-icon. You can find more information on how metastatic breast cancer is diagnosed on our pages about Metastatic Breast Cancer and Testing.

If you had early-stage triple-negative breast cancer, the metastasisinfo-icon is likely to be triple-negative as well. Your medical oncologistinfo-icon may recommend you have a biopsyinfo-icon of any abnormalinfo-icon finding from an imaginginfo-icon test. The biopsy helps to:

  • Diagnose the cancer
  • Confirm the cancer is metastatic
  • Check the receptorinfo-icon status to make sure it did not change from your original diagnosisinfo-icon

Receiving a diagnosis of metastatic triple-negative breast cancer can feel scary. TNBC does not respond to hormonal or HER2-targeted therapies. Since only 15 to 20 percent of breast cancers are triple-negative, you may feel alone.

It may be helpful to understand that many chemotherapy options are available to treat triple-negative breast cancer, and other medicines can lessen side effects. People with TNBC are educating the public about this diagnosis, while doctors and researchers are actively focused on finding new treatments.

Treatments for Metastatic Triple-Negative Breast Cancer

One myth about treating metastaticinfo-icon TNBC is that there aren’t effective treatment options. The truth is that an array of treatments can improve your care. Your treatment options include many chemotherapyinfo-icon medicines and may also include targeted therapies that treat some triple-negative breast cancers with specific features.

How do you choose from the many available chemotherapy options? It is important to talk with your doctors about how you wish to balance the goals of keeping the cancer under control as long as possible and maintaining your quality of lifeinfo-icon, or overall enjoyment of life.  

Another important point about treating metastatic TNBC is that if you had early-stageinfo-icon disease, you can retry medicines you were treated with before. A certain treatment may have failed to get rid of the primary disease, but that treatment could still control it in the metastatic setting.

Common chemotherapy treatments for metastatic triple-negative disease are:

Other chemotherapy treatments are:

  • Capecitabine (Xeloda), given alone or with docetaxelinfo-icon or paclitaxelinfo-icon, is effective against some cancers that stop responding to anthracyclines or taxanes.
  • Vinorelbine (Navelbine) prevents the function of microtubules, which help cancer cells divide. It can be used alone or with other chemotherapy medicines.
  • Gemcitabine (Gemzar) works by starving cancer cells of the nutritioninfo-icon they need to grow. Gemcitabineinfo-icon, given with paclitaxel, is FDAinfo-icon approved for use when an anthracyline stops working or you can’t take it for other reasons.
  • Ixabepilone (Ixempra) stops the growth of tumor cells by targeting a proteininfo-icon called tubulin that helps cells multiply. It is approved for use when other chemotherapy medicines don’t work against the cancer or when the cancer stops responding to treatment.
  • Eribulin (Halaven) stops the cancer cells from dividing into new cells by interfering with the parts of the cell that help move the information inside them during cell division. It is approved for use in people whose metastatic breast cancer has grown after treatment with at least two other types of chemotherapy, including an anthracyclineinfo-icon and taxaneinfo-icon.

In recent years, the FDA has approved treatments that target specific features of some, but not all, triple-negative breast cancers. These are often given alongside chemotherapy. Your doctors can run tests to see if these medicines are appropriate for your treatment.

There are two immunotherapies, medicines that prompt your body’s immune systeminfo-icon to recognize breast cancer cells as a disease and kill them:

  • Pembrolizumab (Keytruda) is approved for any metastatic breast cancers that are microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR). It is given alongside chemotherapy if the cancer has grown after previous treatments.
  • Atezolizumab (Tecentriq) is approved to treat metastatic triple-negative breast cancerinfo-icon that expresses the PD-L1 protein. It is given with the chemotherapy nab-paclitaxel.

Other treatment options include:

  • Olaparib (Lynparza) is part of a family of medicines called PARPinfo-icon inhibitors that cause cancer cells to die by stopping the PARP enzyme from repairing cancer cell DNA. It is given to people who have tested positive for a mutationinfo-icon in either the BRCA1info-icon or BRCA2info-icon geneinfo-icon and who have already had cancer grow while on treatment with chemotherapy.

Clinical Trials in Metastatic Triple-Negative Breast Cancer

Research is underway to find subtypes of TNBC that respond to new and emerging targeted treatments. You may consider taking part in a clinical trial, a study that looks at how well new medical approaches work in people. Clinicalinfo-icon trials offer access to new treatments that are not otherwise available and may prove to work better than standard treatments. Participating in a clinical trialinfo-icon also helps researchers develop better treatments for people diagnosed in the future. 

May 21, 2019