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Triple Negative Breast Cancer: A New Clinical Trial and Must Know Info.

June 19, 2018

Triple negative breast cancer…even the name sounds a bit scary. While we have made great progress against breast cancer, TNBC treatments have lagged behind, with some estimates at a survival rate 20% less than the more “traditional” forms of breast cancer. Much of this seems to boil down to breast cancer stem cells, which in TNBC are highly resistent to chemotherapy, accounting for the higher failure rates and the increased chances for recurrence. When we say TNBC, we are discussing a condition where the Estrogen receptor, the Progesterone receptor and “HER-2 Neu” receptor are all absent when testing for them on the surface membrane of the breast cancer cell. Basically, we are talking about one out of every ten breast cancer cases. TNBC tends to affect younger women, women who are BRCA positive as well as a disproportionate number of African American and Hispanic women as well. Here are some things to know about TNBC.

 

PARP inhibitors are drugs that work at the level of DNA repair. Basically, even cancer cells need a certain amount of good DNA for them to replicate. Cancer cells, unlike non-cancerous ones, depend on “PARP” to repair their DNA, whereas non-cancerous cels have many different ways to repair DNA. PARP inhibitors are used now in ovarian cancers and in BRCA-positive cancers. . By adding the PARP inhibitor drugs to patients with BRCA 1 or BRCA 2 mutations, it seems to improve overall survival in this specific subset of breast cancer patients.
New drug combos are being looked at immunotherapy and PARP inhibitors. The goal is to make the immune system “wake up” and attack the breast cancer. Presently, they are looking at Keytruda combined with PARP inhibitor.

A recent German trial of Carboplatinum hints that adding this drug may improve the disease free survival at 7 years time. In fact, there is substantial literature about the role of giving chemotherapy before surgery, in term of improved survival.

 

Recently, researchers at the Mayo Clinic, as part of the Breast Cancer-Genome Guided Therapy clinical trial, found that low dose Decitabine, which is now FDA approved to treat myelodysplastic syndrome, may have a role in treating TNBC when DNA-methyl transferase proteins are being expressed.

 

Present research is also looking at the role of epigenetic inhibitors and proteins such as “Connexin 26”, which ordinarily plays a role in cell-to-cell communication, but may also support TNBC growth.

Keep in mind that TNBC is NOT one disease. Within it, there are several subgroups based on difference in gene expression. BRCA 1 and BRCA 2 testing should be done on triple negative breast cancers, because PARP inhibitors may play a role in treatment.

A new multicenter clinical trial based out of Cedars-Sinai has also found that the amino acid “asparagine” may help fuel the growth of TNBC cells. Limiting the action of “asparagine synthetase” may help limit the spread. In animal studies, when given foods rich in asparagine, the cancer cells spread more quickly. Most fruits and vegetables are low in asparagine...whereas most other things are high, such as meat, soy, dairy, whey protein, eggs, chicken, turkey, fish, potatoes, seeds, whole grains, nuts and legumes.

 

A new clinical trial treatment program for TNBC is available at 914-666-1366, which is the Clinical Trial Program at Northern Westchester Hospital in New York.