Questions and Experts Session Guide: A Medical Oncologist Answers Questions about Triple Negative Breast Cancer

A breast cancer diagnosis comes with so many questions and there never seems to be enough time at appointments to have some of these questions answered. To help address this, we developed a "Q&E: Questions and Experts" series. In this series, a variety of experts spend the entire virtual session answering pre-submitted and live questions from participants. Watching the videos on-demand might be a little difficult to get through. So, we’ve created this guide to help you get right to the questions and answers that matter the most to you.

In today’s post, we provide the questions that were sent in and asked during the live session of our Questions and Experts session held in November 2021. In this session, Dr. David Cescon, MD, FRCPC, a Medical Oncologist and Clinical Scientist at the Princess Margaret Cancer Centre, answered questions about Triple Negative Breast Cancer (TNBC). In the parentheses, you’ll find the timestamp of where to find the question in the on-demand video.

What is TNBC?

1. Could you provide us with a high-level overview of what Triple Negative Breast Cancer (TNBC) means? (00:03:10)

Testing, Screening and Scans

1. Given that TNBC is essentially an absence of a target, would it be helpful for patients with TNBC to receive genomic testing or some type of additional testing to see if they have a marker that may help provide information about their cancer? (00:05:24)
2. In terms of the standard of care across Canada, should all TNBC patients be receiving germline testing to see if they have a BRCA1 of BRCA2 mutation to inform their treatments? (00:11:45)
3. Would 3D mammograms be more effective than a regular mammogram for dense breasts and after a lumpectomy and reconstructive fat grafting? (00:21:10)
4. Is there any benefit for using tumor-based genomic profiling and protein receptor for early-stage TNBC to help in the case of recurrence? (00:50:58)
5. Given that the nature of the recurrent tumor is usually biologically the same as the original tumor, would it be beneficial to test the original tumor? (00:52:16)
6. Would circulating DNA testing be a tool to measure if somebody could recur? (01:07:16)
7. Is circulating DNA testing costly? (01:11:48)

Treatment

1. In terms of the standard of care across Canada, should all TNBC patients be receiving germline testing to see if they have a BRCA1 of BRCA2 mutation to inform their treatments? (00:11:45)
2. Does chemotherapy increase your risk of being diagnosed with other diseases? (00:43:39)
3. Could patients still have symptoms or develop symptoms years after having chemotherapy? (00:45:48)
4. What is the recommended treatment after chemotherapy and radiation? Is there anything else aside from Zometa? (00:46:51)
5. When is the addition of Xeloda recommended as part of chemotherapy? (00:49:22)
6. Other than immunotherapy, are there other treatments that you see coming down the pipeline that would be promising for TNBC? (01:15:54)
7. How will the approval of new adjuvant treatments for TNBC in Canada affect patients that have already completed treatment within the last five years or more? (01:21:35)
8. Are there any immunotherapy or alternative medicine supplements which would be helpful? (01:24:27)
9. Is radiation the standard treatment with TNBC for a patient that has had a mastectomy? (01:25:33)

High Risk and Recurrence

1. If a patient is diagnosed with TNBC and it does not have the BRCA1 or BRCA2 genes, does that automatically put a family member at high risk, similar to how it would if it had been discovered that the patient had the BRCA gene? (00:15:54)
2. Are there specific scans that should be used to help detect recurrence? (00:21:22)
3. What factors increase or decrease a risk of recurrence? (00:27:38)
4. When someone recurs five years later or more, how often do they recur and have a different biology with their tumor? (00:30:53)
5. For someone who had TNBC 15 years ago and then recurred two years ago with cells in their lymph nodes, does that place them at a higher risk of recurrence? (00:35:03)
6. What are some things that patients can do to reduce their risk of recurrence? For example, does alcohol increase the risk of recurrence? (00:37:18)
7. If someone has applied all this to their lifestyle before a diagnosis: not drinking, good exercise, good quality of life; how do you change or modify their lifestyle after being diagnosed? (00:39:31)
8. What are some of the signs and symptoms that patients can look out for in regard to possible recurrence? (00:41:16)
9. Is there any benefit for using tumor-based genomic profiling and protein receptor for early-stage TNBC to help in the case of recurrence? (00:50:58)
10. Given that the nature of the recurrent tumor is usually biologically the same as the original tumor, would it be beneficial to test the original tumor? (00:52:16)
11. Would circulating DNA testing be a tool to measure if somebody could recur? (01:07:16)
12. Is the PTEN variant gene a risk? (01:27:01)

Metastatic Triple Negative Breast Cancer

1. Do you see more patients with TNBC who are metastatic at their first diagnosis (de novo metastatic) compared to those with HR-Positive or HER2-Positive patients? (00:18:10)
2. Would using a chest x-ray be helpful in detecting a tumor that has spread? (00:26:21)
3. Is there anything promising in terms of research, clinical trials, or vaccines, for both early-stage and metastatic TNBC? (01:13:23)

Clinical Trials and Research

1. There is currently a clinical trial with the Signatera tumor marker testing, is it possible for patients outside of the Toronto area to participate in any of these clinical studies? (00:54:05)
2. Is there anything promising in terms of research, clinical trials, or vaccines, for both early stage and metastatic triple-negative breast cancer? (01:13:23)
3. Other than immunotherapy, are there other treatments that you see coming down the pipeline that would be promising for TNBC? (01:15:54)
4. What’s the most promising thing you see in the near future? (01:17:24)
5. Do you think that with what's coming down the pipelines, are we still moving with the progress and the times? (01:18:58)
6. How will the approval of new adjuvant treatments for TNBC in Canada affect patients that have already completed treatment within the last five years or more? (01:21:35)

Photo by Dragonfly Ave on Unsplash