Positive article on TNBC

Sorry the link seems to be not working cut &  pasting the same  ( hope I am not violating any copy rights)..Sorry for the long post , but want to share  something positive with you all..

 Talking With Patients About a Diagnosis of Triple-Negative Breast Cancer: An Expert Interview With Dr. Hope Rugo
Faculty and Disclosures

Editor's Note:

Although they constitute fewer than 20% of all breast tumors, triple-negative cancers are responsible for a disproportionate number of cases and deaths among young women.[1] Such statistics leave many women who receive a diagnosis of triple-negative disease feeling hopeless. Still, studies in the last decade have demonstrated that patients with triple-negative disease have a substantially better response to conventional chemotherapy than women with other breast cancer types.[2,3] However, too often these data are overlooked or misunderstood by patients. To find out how clinicians can discuss and explain the implications of a diagnosis of triple-negative breast cancer with their patients, Sandra A. Finestone, PsyD, a member of the Susan G. Komen for the Cure Steering Committee for the Breast Cancer Curriculum on Medscape, and herself a breast cancer survivor, interviewed Hope S. Rugo, MD, Clinical Professor of Medicine and Director, Breast Cancer Clinical Trials Program at the University of California at San Francisco. Their conversation is both revealing and instructive and is presented to help clinicians communicate more effectively with women who have just received a diagnosis of triple-negative breast cancer.

Dr. Finestone: I've been noticing that patients with triple-negative breast cancer are often very worried about their diagnosis. Are you seeing the same thing in your practice?

Dr. Rugo: Yes, I do think a diagnosis of triple-negative breast cancer tends to generate a lot of unnecessary fear. For example, I saw a patient yesterday who was diagnosed with triple-negative breast cancer a year ago. At the time of her diagnosis, she felt that it [triple-negative breast cancer] was a death sentence; that there was no point to treatment because it was not curable, because it is such a horrible disease. I had a lengthy conversation with her about how triple-negative breast cancer is treatable and even curable, but she could not be reassured. She had heard from so many people that triple-negative disease is akin to being given a death sentence.

First of all, the diagnosis of breast cancer is quite scary in general. Patients often hear that it is better to have hormone receptor-positive disease rather than HER2-positive disease, or vice versa. But when people hear that they have triple-negative breast cancer, they feel like they have just been given a death sentence, that their survival is going to be 18 months, and everything is terrible.

Dr. Finestone: How many patients really understand the implications of triple-negative breast cancer? Would it help to have an explanation readily available?

Dr. Rugo: Very few patients understand the concept of triple-negative breast cancer. For that reason, I do have an explanation ready. I think the important thing is to tell patients that not only is triple-negative breast cancer very treatable, but it is also worthwhile to look at clinical trials because they offer patients additional options.

Dr. Finestone: Based on that, how does the clinician translate the diagnosis of triple-negative breast cancer for the patient?

Dr. Rugo: I think it really requires explaining to a patient -- and then having her believe you -- about the biology of breast cancer and how we treat it. The best way is to start off by telling the patient that triple-negative disease is a type of breast cancer that does not respond to hormone therapy or HER2-directed therapy. However, because triple-negative tumors grow rapidly in the early-stage setting, they are much more likely to respond to chemotherapy. In fact, chemotherapy can be very effective at controlling the disease. If one looks at the neoadjuvant data, although a complete pathologic response rate of 15%-18% is seen among patients with all breast cancers, the pathologic response rate in patients with triple-negative disease is quite a bit higher.[2,3] In fact, if a patient has triple-negative breast cancer, there is a very good chance that chemotherapy -- either neoadjuvant or adjuvant -- will induce disease remission.

If a patient has triple-negative breast cancer, there is a very good chance that chemotherapy -- either neoadjuvant or adjuvant -- will induce disease remission.
The metastatic setting is a little different, but not that much. Again, we should emphasize that we try to use the best possible chemotherapy regimens. We also need to know what clinical trials are available and discuss these with our patients.

The important thing is that not all cases of triple-negative breast cancer are the same. There is a subgroup of triple-negative tumors that progresses very rapidly and is quite chemotherapy-resistant, but it is only a subset. However, it is worth noting that this subset of rapidly progressing triple-negative breast cancer may be particularly responsive to new targeted therapies.

That is really how I explain triple-negative breast disease to patients -- that this kind of cancer often is quite responsive to chemotherapy, which is a very good treatment for triple-negative breast cancer.

Dr. Finestone: I think that is a message that patients really need to hear because there is this misunderstanding that there are no effective treatments for triple-negative breast cancer.

Dr. Rugo: Right, and that's absolutely not the case.

Dr. Finestone: How would a clinician in a rural, small practice setting start the discussion?

Dr. Rugo: The clinician should emphasize that the standard therapy really does work. The reasons that triple-negative breast cancer has gotten a lot of negative press are 1) because a small number of triple-negative cancers are seen in patients with inherited mutations, and 2) in contrast to HER2-positive breast cancer, we do not have a targeted therapy like trastuzumab with which to treat triple-negative disease.

Ideally, regardless of the practice setting, the clinician should strive to have an open dialogue with the patient, discussing and considering all appropriate treatment options, including clinical trials. I also think it is worthwhile to consult with other physicians who might have greater familiarity with certain types of cancer. In this way, treatment may be optimized while allowing the patient to remain in her own community. However, it is worth noting that geography may determine access to certain clinical trials and, therefore, access to certain types of treatment.

Dr. Finestone: Do you think that there is any advantage to describing a spectrum of disease and positioning triple-negative breast cancer within that spectrum?

Dr. Rugo: The concept of early vs late disease is certainly a type of spectrum physicians could use when describing disease to their patients. Another important area for patient education is biology. For example, the clinician can explain that a very slow-growing tumor, even with 5 positive axillary lymph nodes, is not going to respond to aggressive chemotherapy and is associated with a risk for recurrence over the subsequent 10-20 years. With triple-negative breast cancer, the recurrence risk is front-loaded; that is, it is more likely to occur within the first 3-5 years after diagnosis. The upside, however, is that chemotherapy is much more likely to be effective. It is really a question of biology.

Dr. Finestone: Unfortunately, the messages about triple-negative breast cancer have gotten a bit skewed. Can triple-negative disease be viewed positively because it can be treated quite effectively with chemotherapy?

Dr. Rugo: I say to people, "It is information. It is not bad or good." For instance, if a patient with triple-negative disease is cured right up front, she is done with treatment. In contrast, a patient with hormone receptor-positive breast cancer potentially has to take hormone therapy for at least 5 years, and recently we have been exploring treatment for up to 10 and 15 years because of the risk for late recurrences.[4] There are those sorts of hidden benefits for patients with triple-negative disease.

In addition, we are looking into a variety of different treatments, like antiangiogenic agents, that might help to improve outcomes for patients with triple-negative breast cancer. Specifically, there are a number of trials examining the efficacy of add-on bevacizumab across the spectrum of triple-negative disease.[5]

We have quite a number of patients who come from far away, sometimes from rural areas, to participate in post-neoadjuvant therapy trials. We have even treated a woman who lived as far away as Alaska. She was a young woman, with extensive triple-negative disease at the time of surgery, as well as after chemotherapy. In fact, her doctors stopped her chemotherapy early due to poor response. She enrolled in one of our clinical trials that included bevacizumab and has now been disease free for 2 years. Triple-negative breast cancer is really a disease that we can treat, and I think we are treating it more and more effectively.

Dr. Finestone: When and how would you recommend that patients with triple-negative breast cancer consider participation in a clinical trial?

Dr. Rugo: I think any patient who is undergoing treatment should at least be thinking about what trials are available to her. Clinical trials are not for everybody. But there are many options out there, and it is really important to explore them. There is an excellent, relatively new Website, organized in collaboration with the National Cancer Institute, called breastcancertrials.org, which will match patients with available trials. Breastcancertrials.org also provides a lot of information for patients, such as what a clinical trial is and what it entails. It would be worthwhile for physicians and patients to look at the site and see what approaches are being studied to improve breast cancer care.

There is also the National Comprehensive Cancer Network (NCCN), which issues guidelines about the standard types of treatment for triple-negative breast cancer. For example, I recently saw an out-of-state patient with triple-negative breast cancer who came to the appointment with molecular diagnostic lab work ordered by her referring physician. Although molecular diagnostic testing can be helpful in guiding hormone receptor-positive breast cancer treatment, in this case, use of such a test is contrary to the standard of care for triple-negative disease. By utilizing the NCCN Website, physicians are able to review and discuss standard treatment algorithms with their patients. I think that is also really helpful.

Using these kinds of tools can be empowering for patients. A patient faced with a diagnosis of triple-negative breast cancer may have to counter a great deal of misinformation from well meaning friends and loved ones. What she needs to understand is that this disease is not so terrible, that it is a very treatable cancer.

Dr. Finestone: I think the key to a meaningful, reassuring conversation with patients is exactly what you have explained, namely that triple-negative breast cancer is very treatable and can have a very good outcome.

Dr. Rugo: I think that is absolutely the case. Even in cases of relapsed and metastatic disease, there are a lot of new treatment options. So I think that the most helpful thing to do with patients is to provide them with as much information as possible before they begin any treatment. It is usually better for the patient to take the time to consider all options than to just rush into treatment due to anxiety.

I'd like to reiterate that not all triple-negative cancer is the same. We have seen patients who respond to each therapy for a year or longer in the metastatic setting, and then we have some patients whose cancers progress very rapidly. Physicians and patients should not make assumptions about how a tumor will respond to chemotherapy until treatment begins and responsiveness can be evaluated. Many of my patients with triple-negative disease have done well on treatment for years. The name of the game is to continue the treatment and continue to pay attention to quality of life.

This activity is supported by an independent educational grant from Susan G Komen for the Cure.

Mccrimmon,

Think the article was published at some point in year 2009 . Thanks for sharing this on " Calling all TNS thread"  probably will get more visibility on that post.

I will delete this one after few days.

Zoe