Breast Cancer Specialist Presents Positive Results for Triple-Negative Breast Cancer Presurgery Chemotherapy Benefits
A breast cancer specialist and clinical researcher at Women & Infants Hospital of Rhode Island presented research yesterday at the 2014 San Antonio Breast Cancer Symposium showing that adding either the chemotherapy drug carboplatin or the blood vessel-targeting drug bevacizumab to the standard treatment of chemotherapy before surgery helped women who have the basal-like subtype of triple-negative breast cancer.
“We found that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates for women with basal-like cancers - that is, it increased the proportion of women who had no residual cancer detected at surgery. At the same time, we found that while carboplatin had a similar effect in the smaller group of triple-negative patients with nonbasal-like cancers, adding bevacizumab actually decreased response rates for women with nonbasal-like cancers,” says William M. Sikov, MD, associate chief of clinical research with the Program in Women’s Oncology at Women & Infants and associate professor of medicine at The Warren Alpert Medical School of Brown University.
Last year, Sikov and colleagues reported in a randomized, phase II clinical trial called CALGB/Alliance 40603 that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates in 443 women with operable stage II or III triple-negative breast cancer. These latest results are based on analysis of tissue samples obtained before patients started treatment, correlated with findings at surgery after treatment. Pretreatment tumor samples from 360 of the patients showed that 314 were basal-like and 46 nonbasal-like.
“We have also looked at expression of variety of gene signatures in the pretreatment tissue samples to determine if they benefit from the addition of bevacizumab or carboplatin” Sikov says. “We found that gene signatures characteristic of high proliferation rates and low estrogen-receptor signaling, which are both considered characteristics of more aggressive disease, are associated with higher rates of response rates overall and increased benefit from adding bevacizumab.”
Other studies using tissue and blood samples obtained from the patients treated on this study - funded by the National Cancer Institute, Roche-Genentech, and the Breast Cancer Research Foundation – are ongoing.
Triple negative breast cancer
Women who develop breast cancer under the age of 40 are more likely to have triple negative breast cancer than older women with breast cancer. Black women with breast cancer are more likely to have triple negative breast cancer than white women with breast cancer.
Many breast cancers have receptors for the hormones oestrogen and progesterone, or less commonly for a protein called HER2. These receptors can stimulate the cancers to grow. After surgery, the tissue that is removed from a woman’s breast is tested for receptors.
Women who have breast cancer with hormone receptors are prescribed hormonal treatments, such as tamoxifen or anastrozole. Women with breast cancers that have high levels of HER2 receptors are given a drug called trastuzumab (Herceptin®).
If you have a breast cancer that doesn’t have any oestrogen, progesterone or HER2 receptors, this is called triple negative breast cancer. Women with triple negative breast cancer don’t benefit from treatment with hormonal therapy or Herceptin. Chemotherapy is more effective for women with triple negative breast cancer.
Basal cell breast cancer
The term basal cell breast cancer is often linked with triple negative breast cancer. Basal cell is a type of breast cancer that is identified when the cancer cells are examined under the microscope.
Most triple negative breast cancers are basal cell cancer and basal cancers are usually triple negative.
Causes and risk factors
The risk factors for triple negative breast cancer aren’t clear. Breast cancers that depend on hormones to grow are linked with risk factors to do with having children, such as how old a woman was when she had her first child. Triple negative breast cancer doesn’t seem to share these risk factors.
Most women with triple negative breast cancer don’t have a strong history of breast cancer in their family (hereditary breast cancer). However, some women with triple negative breast cancer have a faulty gene called BRCA1. This gene is inherited from a parent and can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.
Sikov sees patients at the Program in Women’s Oncology Breast Health Center offices in Providence. For an appointment, call (401) 453-7520.
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women’s medicine, Women & Infants is the 11th largest stand-alone obstetrical service in the country with approximately 8,400 deliveries per year. A U.S.News 2014-15 Best Children’s Hospital in Neonatology and 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened the country’s largest, single-family room neonatal intensive care unit.
What is Triple Negative Breast Cancer?
A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth-estrogen, progesterone, and the HER-2/neu gene- are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR). Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.
Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s only mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Center of Excellence the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute’s Gynecologic Oncology Group and the Pelvic Floor Disorders Network.
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