January 15, 2015 | by Nicole White
When Homa Sadat found a lump in her breast at age 27, her gynecologist told her what many doctors say to young women: You’re too young to have breast cancer.
With the lump dismissed as a harmless cyst, she didn’t think about it again until she was at a restaurant six months later and felt shooting pain. She went back to her doctor and asked for a biopsy. The biopsy confirmed her fear: She had breast cancer. A biopsy of a suspicious lymph node in the underarm area confirmed that the cancer had spread.
Sadat was diagnosed with what's known as triple-negative breast cancer.
When pathologists test breast cancer cells, they look for the presence of estrogen and progesterone hormone receptors and the overexpression of receptors for a type of protein called HER2. Breast cancer that is positive for one of the hormone receptors can be targeted with hormonal therapy such as tamoxifen or aromatase inhibitors. Other therapies, like trastuzumab (Herceptin) or its newer versions, have been developed to target HER2 overexpressive – that is, positive – breast cancers.
Cancers that are negative for all three receptors are often referred to as triple-negative cancers. They're the toughest to treat.
Agrressive approach to triple-negative breast cancer
City of Hope researchers have an intense interest in studying these cancers, in hopes of discovering more effective treatments.
“Triple-negative breast cancer represents approximately 15 percent of all breast cancers, but it is diagnosed at a higher rate in patients with hereditary (particularly BRCA1-gene associated) breast cancer, as well as among African-American women. We have several innovative clinical trials both for newly diagnosed and Stage 4 triple negative breast cancer patients that play into efforts going on nationally to address these difficult to treat tumors,” said George Somlo, M.D., professor in the departments of Medical Oncology & Therapeutics Research and Hematology & Hematopoietic Cell Transplantation at City of Hope.
“Our current focus is to treat newly diagnosed triple-negative breast cancers aggressively in the preoperative setting, in order to destroy cancer cells even before patients are operated upon,” Somlo said. “Once the tumor is completely eliminated or at least reduced in size with chemotherapy, surgery follows. In fact, patients with newly diagnosed triple-negative breast cancer without recurrence within the first five years after diagnosis are likely cured.”
Sadat initially sought treatment at another center, and while she was confident in her surgeon there, she said the oncologist made her feel scared. She came to City of Hope for a second opinion.
“I did not feel a one-on-one investment from that doctor,” Sadat said. “I felt like I was just another patient. I read up on Dr. Somlo, and I knew he’d done studies on women with triple-negative breast cancer. When I met him, the first thing I said was ‘Sign me up.’”
Knowing that Somlo had successfully treated women with her type of cancer gave her confidence, Sadat said, and she enrolled in a City of Hope phase II clinical trial that offered chemotherapy before she underwent surgery. She was treated with carboplatin and a novel nanoparticle drug: nab-paclitaxel (Abraxane).
After eight weeks on the chemotherapy regimen, she said, the tumor had shrunk significantly. She volunteered for a research biopsy – but had a pleasant surprise instead.
“I went in for an ultrasound-guided biopsy, and they said there’s nothing to biopsy,” Sadat said. “They couldn’t find the tumor.”
Ongoing research, ongoing advances
Sadat continued on for another eight weeks and in January of 2013, she underwent surgery at City of Hope to remove the part of her breast tissue that had initially contained the breast tumor, as well as several lymph nodes. No cancer cells were found in the removed tissues – Sadat’s cancer had gone into complete remission.
Somlo is close to completing this particular clinical trial as well as a randomized phase II national study assessing the role of the drug carboplatin and the PARP-inhibitor veliparib aimed at patients with Stage 4 BRCA1- and BRCA2-associated breast cancer.
“We are learning that triple-negative breast cancer is an entity consisting of at least a half-dozen subtypes, each of which may require personalized therapies,” Somlo said. “We need to particularly intensify our current laboratory and translational research to improve our next generation clinical trials for much better control and eventual cure of triple-negative Stage 4 metastatic breast cancers."
He added: "The next generation of trials we are working on will have to be more tumor-target specific, so we can help individual patients presenting with their particular subtypes of triple-negative breast cancer.”
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.