What is the most common misconception about triple negative breast cancer?

Massimo Cristofanilli: The most common misconception is that triple negative breast cancer (TNBC) is a uniform disease. The clinical classification, based on the lack of expression of estrogen or progesterone receptors and HER2, provides a reductive view of the disease biology compared to the molecular analysis, indicating a complex and heterogeneous disease.

What are some of the particular challenges patients with TNBC face?T

The consequences of our current standard approach to the management of TNBC are many, but chiefly that cytotoxic chemotherapy provides little benefit because of the intrinsic chemo-resistance of this disease. Moreover, one of the most challenging aspects of managing TNBC patients is the development of visceral metastasis as a typical progression pattern.

“Compared to other subtypes of breast cancer in which we have identified therapeutic targets, in this disease we have limited choices. And this translates to short survival.”

Why is treating TNBC so different than treating more common breast cancers?

TNBC is a chemo refractory disease with the ability to quickly progress to visceral organs. Compared to other subtypes of breast cancer in which we have identified therapeutic targets, in this disease we have limited choices. And this translates to short survival.

What is it going to take to advance treatment of this type of breast cancer to the next level?

The application of next-generation sequencing to molecular diagnostics of TNBC failed to reveal any actionable genomic abnormality. This suggests that we will have to investigate other molecular features of TNBC to improve our treatments.

The ability to modulate drug resistance, regulate the metastatic process and improve immune response to the disease — these are some of the strategies that should be employed in metastatic breast cancer management. Drug-resistance is particularly relevant for a subset of cancer cells known as cancer stem cells. If we could develop a strategy to combine therapies that target the various types of cancer cells, including the stem cells, we will be more successful in controlling the disease and likely improve survival. There are currently promising, ongoing clinical trials exploring this opportunity.

What is your best piece of advice for a patient recently diagnosed with triple negative breast cancer?

Please discuss with your physician the availability of clinical trials for your disease. The possibility to access novel drugs and contribute to the establishing the value of novel therapies is critically important in TNBC. We understand the clinical behavior of this disease and the need to discuss clinical trial early in the treatment process.