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Breast Cancer Breakthroughs Episode 4: Unmet Needs in TNBC

Triple negative breast cancer (TNBC) is one of the most aggressive and complex types of breast cancer to treat. Because TNBC lacks the estrogen receptor, progesterone receptor and HER2, it cannot be treated with targeted therapies that work for other breast cancer types. While the prognosis for TNBC is slowly improving, patients with TNBC are in critical need of better treatment options.  

In this episode of Breast Cancer Breakthroughs, we speak with Dr. Lisa Carey, a medical oncologist at UNC Lineberger Comprehensive Cancer Center, and Dr. Tiffany Traina, a medical oncologist at Memorial Sloan Kettering Cancer Center, about the latest research developments that are bringing promising new treatment options to TNBC patients. 

More and Better Treatment Options for TNBC Patients  

“The biggest unmet needs for metastatic triple-negative breast cancer are that, in spite of a number of quite impressive advances, we are still heavily dependent on chemotherapy, or chemotherapy-based approaches, and we really don’t have good targeted treatments,” says Dr. Carey. 

Many who are living with TNBC today face limited treatment options that are often difficult to endure. In her own treatment for early TNBC, Susan G. Komen CEO Paula Schneider has experienced these challenges firsthand. 

No cancer treatment is a walk in the park, but when I was diagnosed with triple negative breast cancer in 2007, I learned this meant there were three types of cancer they had better treatments for than mine – and I felt that daily,” says Schneider. 

“My doctor told me right away, ‘This will be rough.’ He was right. My course of treatment was so difficult and unpleasant, they don’t even offer it to patients anymore.” 

But as Dr. Carey discussed in the video, there are now improved treatment options for early and metastatic TNBC patients. This includes PARP inhibitors for those with BRCA1 or 2 germline mutations, immunotherapy and antibody-drug conjugates (ADCs), which deliver highly potent chemotherapy agents directly to tumor cells. 

ADCs have already been proven superior to chemotherapy in some situations. As patient advocate Marlena Murphy explains, “Patients are excited that the antibody-drug conjugates are designed to attack only the cancer cells.” 

Advances for Metastatic TNBC Patients  

For people living with metastatic TNBC, the first line of treatment is chemotherapy or a combination of chemotherapy and immunotherapy. Only 40% of patients are eligible for immunotherapy, meaning the remaining 60% of patients have no other options besides chemotherapy. 

New advancements in research have led to ADCs becoming an option for people with TNBC. One option is sacituzumab govitecan, which was approved by the FDA in 2021 for treating metastatic TNBC. New clinical trials are currently investigating other treatments that could bring additional options and hope for people living with TBNC.  

Dr. Carey discusses clinical trials that are investigating new therapies for metastatic TNBC, including the TROPION-Breast02 trial, which could bring a new first-line therapy option to patients with metastatic TNBC. This treatment, an ADC called Datopotamab Deruxtecan or Dato-DXd, targets a protein called TROP-2 on the surface of TNBC cells and then delivers chemotherapy directly to the cell.  

Dato-DXd has shown high response rates in previous trials. In the video, TROPION-Breast02 Principal Investigator Dr. Tiffany Traina explains what these new findings could mean for patients.  

“There are some really exciting data of this agent in early phase one studies where, in a heavily pretreated setting, response rates to this antibody-drug conjugate are more than 30%,” says Dr. Traina. “And if you look at women receiving this drug who had not seen anything like it before, response rates are (about 44%).” 

Dato-DXd has also been well tolerated by patients. As Dr. Traina explains in the video, TROPION-Breast02 will continue to assess the efficacy of Dato-DXd and how it impacts overall survival. 

Advances in Treatment Bring Hope 

For Schneider, these breakthroughs not only bring promise to those in the TNBC community today but also ensure better outcomes for all TNBC patients in the future. 

“In only 16 years since my diagnosis, we’ve come such a long way in breast cancer research and treatment. TNBC treatment now has fewer side effects and better efficacy than general chemotherapy. This only makes me more optimistic about the advancements yet to come in my lifetime and grateful that no one has to go through the treatment I once endured.” 

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