Lisa Carey, M.D., of the University of
North Carolina, provided an update on the management of metastatic
triple-negative breast cancer at the 2013 San Antonio Breast Cancer Symposium today. It was a
clear overview of previous research, demonstrating that TNBC is a family of
diseases, with varying subtypes that react differently to treatment.
Some of her points:
• 49 percent of all TNBC cases are
basal-like.
• 30 percent are claudin-low, a new
subtype that researchers are just beginning to understand.
• Preclinical studies show that
platinum drugs may be especially effective against basal-like TNBC.
• Conventional chemotherapy is
effective against metastatic TNBC; however, as with all stage IV disease, the
duration of response is often short. Several studies have found median survival
after diagnosis of stage IV disease of approximately 1-2 years.
• PARP inhibitors are effective against
BRCA-associated TNBC.
• Weekly paclitaxel was more effective
than ixabepilone and less toxic than albumin-bound nab-paclitaxel in the CALGB
40502 study.
• Eribulin (a halichondrin B analogue) was
effective in the EMBRACE study.
• A phase III comparison of eribulin
and capecitabine may show a slight advantage for TNBC.
• Both eribulin and capecitabine are
“reasonable choices” for TNBC.
• Alternatives include anthracyclines,
platinum drugs, gemcitabine, and doublet regimens.
• Bevacizamab (Avastin) plus chemo improved progression-free
survival in metastatic TNBC but had zero effect on overall survival. Researchers do not know why.
• Randomized clinical trials are
ongoing.
• Androgen-fighting drugs may successfully fight androgen-sensitive subsets of TNBC, as demonstrated at last year's SABCS.
"To advance therapy in metastastic TNBC, we will need to better match the tumor to the target," she said. TNBC may demonstrate that the old strategy of "one size fits all" treatment no longer works for any type of cancer.
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
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2 comments:
Am I reading this correctly when it says that the median life of a stage 4 TNBC patient is 1 - 2 years after diagnosis?
Yes. I do not like that fact, but that is what the research shows. Remember that this a a median, which means half live longer than that. There is lots of research now on metastatic TNBC--it is what absolutely needs and deserves the focus now. We need a targeted therapy for metastatic TNBC, and that is what researchers are looking for. Let's pray they find it soon. It has been amazing to see how one drug, Herceptin, changed the prognosis of Her2-positive breast cancer from being dismal to being rosy. Let's hope we have that drug for TNBC soon.
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