Triple negative breast cancer: what are its peculiarities and how to treat it? : Current Woman The MAG

Each year, around 60,000 people are affected by breast cancer and this makes it the number one cancer in women. This disease is conjugated in the plural, because all breast cancers are different. "To decide on the best treatments and to better understand or anticipate their evolution, we base ourselves on a microscope analysis of the particularities of each cancer subtype", explains Prof. Mahasti Saghatchian, an oncologist specializing in breast cancer at the American Hospital in Paris (Neuilly-sur-Seine). There are three categories of breast cancer subtype:

  • the hormone-sensitive cancer, which has hormone receptors on the surface of its cells. It represents 75% of breast cancers.
  • the HER2 positive cancer, which has receptors called HER2. It represents 10 to 15% of breast cancers.
  • the so-called "triple negative" cancer, which has neither hormone receptors nor HER2 receptors. It also represents 10 to 15% of breast cancers.

Triple negative breast cancer: what are its particularities?

"Triple negative breast cancer is more aggressive than others because it grows quickly and often appears earlier", explains Prof. Mahasti Saghatchian. While the average age of breast cancer onset is 62, triple negative breast cancer most commonly appears between the ages of 50 and 55, with a high prevalence in women under 50. Many of the patients are also under 40.

However, in France, organized screening begins at age 50 and takes place every two years. Not only does triple negative breast cancer often appear earlier and is therefore not detected, but it is also a so-called "interval" cancer: as it is aggressive and grows quickly, it often appears. between two mammograms. These phenomena are the cause of often very significant diagnostic delays.

The other thing about triple negative breast cancer is that even when it is well managed with surgery, radiation therapy and chemotherapy, it tends to recur more easily and quickly than others. . "Within 3 to 5 years, the risk of recurrence in the breast or with metastases in the rest of the body is significant", underlines Prof. Mahasti Saghatchian.

How is triple negative breast cancer identified?

To diagnose breast cancer, a biopsy is performed: a sample of the tumor is therefore taken. An anatomopathological examination is then performed in order to test for estrogen, progesterone and HER2 receptors. In the absence of these receptors, the diagnosis of triple negative cancer can be made.

"An extension assessment must also be carried out, in order to verify that there is only a single outbreak or other outbreaks that are not always visible at the mammogram or breast ultrasound. This is the reason why these examinations can be supplemented by breast MRI ", adds Prof. Mahasti Saghatchian.

A whole body examination, i.e. a PET scan or a bone scan may also be performed. The goal? Check that cancer cells have not spread to other organs, such as the lungs, bones, liver or the brain.

How to treat triple negative breast cancer?

A combination of treatments is needed to optimally manage triple negative breast cancer when it is localized:

  • of the surgery in order to remove the affected part. It can be performed on the breasts and lymph nodes;
  • of the radiotherapy, in case the cells migrate elsewhere than in the breast;
  • of the chemotherapybecause this cancer has a high propensity to spread. This comprehensive treatment helps hunt down cancer cells throughout the body. It can sometimes be helpful to start with chemotherapy before surgery.

Despite this treatment, the risk of recurrence is 40% within 5 years. And in this case, this recurrence is in the form of cancer cells that spread outside the breast: other organs are often affected. This is called metastatic breast cancer. "You have to go back to chemotherapy, but at this point triple negative breast cancer often becomes resistant to treatment", specifies Prof. Mahasti Saghatchian.

Triple-negative breast cancer treatment: patients are mobilizing

What are the possibilities for patients? "The hope lies in particular in immunotherapy combined with chemotherapy", explains the oncologist. In 2019, aezolizumab combined with paclitaxel received a temporary authorization for use (ATU). Following the conclusions of subsequent studies with the molecule, the Haute Autorité de Santé (HAS) had issued an unfavorable opinion to the reimbursement of this treatment in the context of triple negative breast cancer, "given the impossibility of determining the clinical benefit of the combination (…) with regard to the current treatment in France due to the lack of a relevant comparison", can we read in a document from the HAS.

Thus, some patients would spend thousands of euros for treatment abroad, especially in Germany, the United States and Canada, where this treatment is authorized. "In France, it is still possible to benefit from this treatment within the framework ofclinical tests, but only 5% of patients can be included ", specifies Prof. Mahasti Saghatchian.

"Another innovative treatment also offers hope for patients with triple negative breast cancer: sacituzumab govitecan", explains the oncologist. In 2020, it was granted temporary authorization for use in France, but production remains limited for the time being and distribution is currently only guaranteed in the United States. A collective called #MobilizationTriplettes is now campaigning for "to offer every chance of remission and recovery to patients with triple negative breast cancer in France".

Thanks to Prof. Mahasti Saghatchian, oncologist specializing in breast cancer at the American Hospital in Paris (Neuilly-sur-Seine).

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