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Triple-Negative Breast Cancer: Clinical Features

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Triple-Negative Breast Cancer

Abstract

Triple-negative breast cancers (TNBCs) lack expression of the three prognostic and predictive biomarkers routinely used in clinical management. It is a heterogeneous disease and clinically has aggressive tumor biology with the worst disease-specific outcomes as compared to other breast cancer subtypes. The clinical management of TNBC represents an important challenge, and limited treatment strategies are an unmet clinical need. These cancers do not respond to endocrine agents or targeted agents. Chemotherapy is the mainstay of treatment. This chapter describes the epidemiology, risk factors, clinical features, natural history, and prognosis of TNBC.

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References

  1. Allred DC. Issues and updates: evaluating estrogen receptor-alpha, progesterone receptor, and HER2 in breast cancer. Mod Pathol. 2010;23(Suppl 2 (S2)):S52–9.

    Article  CAS  PubMed  Google Scholar 

  2. Hammond MEH, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med. 2010;134(6):907–22.

    PubMed  PubMed Central  Google Scholar 

  3. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31 VN-r(31):3997–4013.

    Article  Google Scholar 

  4. Penault-Llorca F, Viale G. Pathological and molecular diagnosis of triple-negative breast cancer: a clinical perspective. Ann Oncol. 2012;23(Suppl. 6):vi19–22.

    PubMed  Google Scholar 

  5. Lehmann BD, Bauer JA, Chen X, Sanders ME, Chakravarthy AB, Shyr Y, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011;121(7):2750–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lehmann BD, Jovanović B, Chen X, Estrada MV, Johnson KN, Shyr Y, et al. Refinement of triple-negative breast cancer molecular subtypes: implications for neoadjuvant chemotherapy selection. PLoS One. 2016;11(6):1–22.

    Article  CAS  Google Scholar 

  7. Burstein MD, Tsimelzon A, Poage GM, Covington KR, Contreras A, Fuqua S, et al. Comprehensive genomic analysis identifies novel subtypes and targets of triple-negative breast cancer. Clin Cancer Res. 2014;21(i):1688–99.

    PubMed  PubMed Central  Google Scholar 

  8. Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747–52.

    Article  CAS  PubMed  Google Scholar 

  9. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295(21):2492.

    Article  CAS  PubMed  Google Scholar 

  10. Boyle P. Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol. 2012;23(Suppl. 6):8–13.

    Google Scholar 

  11. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer: Lyon; 2013.

    Google Scholar 

  12. Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010;363:1938–48.

    Article  CAS  PubMed  Google Scholar 

  13. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15):4429–34.

    Article  PubMed  Google Scholar 

  14. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer. 2007;109(9):1721–8.

    Article  PubMed  Google Scholar 

  15. Harris LN, Broadwater G, Lin NU, Miron A, Schnitt SJ, Cowan D, et al. Molecular subtypes of breast cancer in relation to paclitaxel response and outcomes in women with metastatic disease: results from CALGB 9342. Breast Cancer Res. 2006;8(6):R66.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LAG, et al. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014;106(5). pii: dju055.

    Google Scholar 

  17. Villarreal-Garza C, Alvarez-Gómez RM, Pérez-Plasencia C, Herrera LA, Herzog J, Castillo D, et al. Significant clinical impact of recurrent BRCA1 and BRCA2 mutations in Mexico. Cancer. 2015;121(3):372–8.

    Article  CAS  PubMed  Google Scholar 

  18. Lara-Medina F, Pérez-Sánchez V, Saavedra-Pérez D, Blake-Cerda M, Arce C, Motola-Kuba D, et al. Triple-negative breast cancer in Hispanic patients: high prevalence, poor prognosis, and association with menopausal status, body mass index, and parity. Cancer. 2011;117(16):3658–69.

    Article  PubMed  Google Scholar 

  19. Brewster AM, Chavez-MacGregor M, Brown P. Epidemiology, biology, and treatment of triple-negative breast cancer in women of African ancestry. Lancet Oncol. 2014;15(13):e625–34.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, et al. Population differences in breast cancer: survey in indigenous african women reveals over-representation of triple-negative breast cancer. J Clin Oncol. 2009;27(27):4515–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sineshaw HM, Gaudet M, Ward EM, Flanders WD, Desantis C, Lin CC, et al. Association of race/ethnicity, socioeconomic status, and breast cancer subtypes in the National Cancer Data Base (2010-2011). Breast Cancer Res Treat. 2014;145(3):753–63.

    Article  PubMed  Google Scholar 

  22. Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. 2007;25(11):1329–33.

    Article  PubMed  PubMed Central  Google Scholar 

  23. KB K, JL H, DR B. al et. Risks of breast, ovarian, and contralateral breast cancer for brca1 and brca2 mutation carriers. JAMA. 2017;317(23):2402–16.

    Article  Google Scholar 

  24. Hall MJ, Reid JE, Burbidge LA, Pruss D, Deffenbaugh AM, Frye C, et al. BRCA1 and BRCA2 mutations in women of different ethnicities undergoing testing for hereditary breast-ovarian cancer. Cancer. 2009;115(10):2222–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Comen E, Davids M, Kirchhoff T, Hudis C, Offit K, Robson M. Relative contributions of BRCA1 and BRCA2 mutations to “triple-negative” breast cancer in Ashkenazi Women. Breast Cancer Res Treat. 2011;129(1):185–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Warner E, Foulkes W, Goodwin P, Meschino W, Blondal J, Paterson C, et al. Prevalence and penetrance of BRCA1 and BRCA2 gene mutations in unselected Ashkenazi Jewish women with breast cancer. J Natl Cancer Inst. 1999;91(14):1241–7.

    Article  CAS  PubMed  Google Scholar 

  27. Greenup R, Buchanan A, Lorizio W, Rhoads K, Chan S, Leedom T, et al. Prevalence of BRCA mutations among women with Triple-Negative Breast Cancer (TNBC) in a Genetic Counseling Cohort. Ann Surg Oncol. 2013;20(10):3254–8.

    Article  PubMed  Google Scholar 

  28. Millikan RC, Newman B, Tse CK, Moorman PG, Conway K, Smith LV, et al. Epidemiology of basal-like breast cancer. Breast Cancer Res Treat. 2008;109(1):123–39.

    Article  PubMed  Google Scholar 

  29. Shinde SS, Forman MR, Kuerer HM, Yan K, Peintinger F, Hunt KK, et al. Higher parity and shorter breastfeeding duration. Cancer. 2010;116(21):4933–43.

    Article  PubMed  Google Scholar 

  30. Kwan ML, Kushi LH, Weltzien E, Maring B, Kutner SE, Fulton RS, et al. Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res. 2009;11(3):R31.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Reis-Filho JS, Tutt ANJ. Triple negative tumours: a critical review. Histopathology. 2008;52(1):108–18.

    Article  CAS  PubMed  Google Scholar 

  32. Kassam F, Enright K, Dent R, Dranitsaris G, Myers J, Flynn C, et al. Survival outcomes for patients with metastatic triple-negative breast cancer: implications for clinical practice and trial design. Clin Breast Cancer. 2009;9(1):29–33.

    Article  PubMed  Google Scholar 

  33. Aapro M, Wildiers H. Triple-negative breast cancer in the older population. Ann Oncol. 2012;23(Suppl. 6):vi52–5.

    PubMed  Google Scholar 

  34. Zhu W, Perez EA, Hong R, Li Q, Xu B. Age-related disparity in immediate prognosis of patients with triple-negative breast cancer: a population-based study from SEER cancer registries. PLoS One. 2015;10(5):1–15.

    Google Scholar 

  35. Syed BM, Green AR, Nolan CC, Morgan DAL, Ellis IO, Cheung KL. Biological characteristics and clinical outcome of triple negative primary breast cancer in older women – comparison with their younger counterparts. PLoS One. 2014;9(7):e100573.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cameron D, Brown J, Dent R, Jackisch C, Mackey J, Pivot X, et al. Adjuvant bevacizumab-containing therapy in triple-negative breast cancer (BEATRICE): primary results of a randomised, phase 3 trial. Lancet Oncol. 2013;14(10):933–42.

    Article  CAS  PubMed  Google Scholar 

  37. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007;13(8):2329–34.

    Article  CAS  PubMed  Google Scholar 

  38. Masuda N, Lee S-J, Ohtani S, Im Y-H, Lee E-S, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–59.

    Article  CAS  PubMed  Google Scholar 

  39. Adams S, Schmid P, Rugo HS, Winer EP, Loirat D, Awada A, et al. Phase 2 study of pembrolizumab (pembro) monotherapy for previously treated metastatic triple-negative breast cancer (mTNBC): KEYNOTE-086 cohort A. American Society of Clinical Oncology Annual Meeting; 2017.

    Google Scholar 

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Correspondence to Rebecca Dent MD, FRCP .

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Tan, T., Dent, R. (2018). Triple-Negative Breast Cancer: Clinical Features. In: Tan, A. (eds) Triple-Negative Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-69980-6_2

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  • DOI: https://doi.org/10.1007/978-3-319-69980-6_2

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