A detail description on Triple Negative Breast Cancer with the explanation of its New treatment.

1. PRESENTED BY- SUBMITTED TO-
Komal Chandrapaxi Dr. CH.N.Kavitha
VP22PHAR0200009 Assistant Professor
M.Pharm(Pharmacology) Pharmacology Department

2. What is Cancer ?
Cancer is the abnormal, uncontrollable , continuous replicationof cells which
will inevitablylead to the formation of a tumor.

3. What is Breast Cancer ?
Breast cancerhappens when cells in your breast grow and
dividein anuncontrolled way, creatinga massof tissue called
a tumor.
Signs of breast cancer can include feeling a lump in your
breast, experiencinga change in the size of your breast and
seeing changesto the skin on your breasts

4. Clinical Breast Cancer Subsets
Defined by IHC
All Breast
Cancers
ER+
65%-75%
HER2+
15-20%
Triple
Negative
15%

5. ’’Triple Negative Breast Cancer”
Theterm triple-negativebreast
cancer refers to the fact that the
cancer cells don’t have estrogen or
progesterone receptors (ERor PR)
and also don’t make any or too much
of the protein called Human
EpidermalGrowth Factor 2 (HER2).
Lacksexpression of biomarkers ER, PR and HER-2

6. • (Thecells test "negative"on all 3 tests.)These cancerstend to be
more common in women younger than age 40, who are Black,or
who havea BRCA1 mutation.
The BRCA1 gene provides
instructions for makinga
protein that acts asa tumor
suppressor. Tumor
suppressor proteins help
prevent cells from growing
and dividingtoo rapidly or in
an uncontrolled way.

7. • TNBC is a more aggressive type
of cancer that grows and
spreadsfaster.
• TNBC has fewer treatment
options than other types of
invasivebreast cancer
• Thisisbecausethe cancercells do not have the estrogen or
progesterone receptors or enough of the HER2 protein to make
hormone therapy or targeted HER2 drugs work.
• Because hormone therapy and anti-HER2 drugs are not choicesfor
women with triple-negativebreast cancer,chemotherapy is often
used.

8. Some Common Characteristics of TNBC
• Triple negative breast cancer is bit more aggressive and difficult
to treat and more likely to recure then cancers that are HR positive
and HER2 positive.
• It is more common in-
- Women agedless then 40
- Black women
- Women who have a BRCA1 mutation.

9. Symptoms of Triple Negative Breast Cancer
TNBC symptoms are the sameas other common breast cancers.
Possible breast cancersymptoms include:
• A new lump or mass.
• Swelling in all or part of a breast.
• Breast pain.
• Breast skin that’sdry, flaking, thickened or red
• Dischargethat is not breast milk
• Swollen lymph nodes (this symptom happenswhen breast
cancerspreadsto the lymph nodes under your arm or near
your collarbone).

10. Diagnosis Of Triple Negative Breast Cancer
• The first step might be a mammogram to evaluate a suspicious
mass or lump in your breast
• Based on what they learn, healthcare providers might perform
a biopsyto remove breast tissue.
1. Magneticresonance imaging(MRI)
2. Ultrasound
3. Computed tomography (CAT) scan
4. Positron emission tomography (PET) scan

11. • When we do biopsy and send it to the lab, a specifictest is done
which iscalled Immunohistochemistry.
• Three strains in the Biopsy that are negative which are
ER – Estrogen level
PR – Progesterone level
HER – HER2 level
• The ER and PR are hormone which are negative.
HER2 is a protein that is negative.
• When these strains are negativethen only we can labelit as Triple
NegativeBreast Cancer.
• Without biopsy we will never be able to diagnoseit.

12. Treatment Of Triple Negative Breast Cancer
Stage by stage the treatment varies-
i. Lumpectomy
ii. Mastectomy
iii. Radiation
iv. Chemotherapy
• TNBC doesn’t have estrogen or progesterone receptors and also
makestoo little or none of the HER2 protein.
• Because the cancer cells don't have these proteins, hormone
therapy and drugs that target HER2 are not helpful, so
chemotherapy (chemo)is the main systemictreatment option.

13. Radiation Therapy
Lumpectomy &
Mastectomy

14. Classificationand therapeuticoptions for TNBC : ADC:antibody‒drug
conjugates; AR:androgen receptor; LAR: luminalandrogen receptor; M:
mesenchymal; MSL: mesenchymal-stem-like;PARP: poly-adenosine
diphosphate ribose polymerase; PI3K: phosphoinositol-3 kinase; TKI:
tyrosine kinaseinhibitor; and TNBC: triple-negativebreast cancer

15. Stages Of Treatment In TNBC
A. Stages I-III triple-negativebreast cancer
Surgery first:
• If the early-stage TNBC tumor is small enough to be removed
by surgery, then breast-conserving surgery or a mastectomy with
a checkof the lymph nodes may be done.
• In certain cases, such as with a large tumor or if the lymph nodes
are found to have cancer,radiation may follow surgery.
• Surgery are found to have:
- A tumor largerthan 2cm but no biggerthan 5cm.
- 1 to 3 axillary (underarm)lymph nodes with cancer.

16. Surgery second:
• Chemo is often given before surgery by itself or
with pembrolizumab to shrink a large tumor or lymph nodes with
cancer.
• If cancer is still found in the tissue removed by surgery after
neoadjuvantchemo has been given, your doctor may recommend:
- An oral chemo drug called Capecitabine (Xeloda) for 18 to 24
weeks. This might help some women live longer.
- More pembrolizumab after surgery (adjuvant treatment) to
reduce the chancesof the cancercoming back.

17. B. Stage IV triple-negativebreast cancer
• Chemo is often used first when the cancer has spread to other
parts of the body. Common chemo drugs used include
anthracyclines, taxanes, capecitabine, gemcitabine, eribulin, and
others. Chemo drugs might be used alone or in combination.
• For women with TNBC who have a BRCA mutation and whose
cancer no longer responds to common breast cancer chemo
drugs, other platinum chemo drugs (like cisplatin or carboplatin)
or targeted drugs called PARP inhibitors (such as olaparib) may be
considered.

18. A New Treatment Option
• On March 11, 2022, the Food and Drug Administration (FDA)
approved a drug called Olaparib (The PARP inhibitor) to treat
HER2-negative,high-riskearlybreast cancer.
• The clinical trial results demonstrated that Olaparib reduced the
riskof death by 32%
PARP Inhibitor (poly adenosinediphosphate-ribose
polymerase): preventingcancercells from repairing,
allowing them to die

19. • Olaparib inhibits poly(ADP‐ribose) polymerase, thereby
blocking the repair of single‐strand DNA breaks. This
results in synthetic lethality in BRCA‐associated cancer
cells, which have a dysfunction of another DNA repair
pathway.

20.  Side effects of this medication cause –
Hemotoxicity
Vomiting
Nausea
Blood in urine or stool
• Some people who have breast cancer and who have received
previous treatment with chemotherapy, radiotherapy, or certain
other medicines for their cancer have developed MDS or AML
during treatment with Olaparib,MDS or AML may lead to death.
- MDS : MyelodysplasticSyndrome
- AML : Acute Myeloid Leukemia

21. Conclusion –
In this presentation, we discuss the characteristics of TNBC,
summarize recent advances in targeted therapy and discuss future
directions to improve the clinicaloutcome of TNBC treatment.

22. References
• New drug target for triple-negativebreast cancer – ScienceDaily.
• https://www.nfcr.org/blog/new-treatment-renewed-hope-for-
triple-negative-breast-cancer-patients-mw-2022/
• Recent advancesin therapeutic strategiesfor triple-negative
breast cancer.

23. THANK YOU