Triple negative breast cancer

The symptoms of triple negative breast cancer are the same as for other breast cancer types.

The tests are the same as for any type of breast cancer. You usually have a:

Your cancer doctor will talk to you about the best treatment for you. This depends on different factors, such as the stage and grade of the cancer. It also depends on whether you have any other health problems.

Treatment for triple negative breast cancer is usually a combination of:

• surgery
• radiotherapy
• chemotherapy.

You may have chemotherapy as your first treatment before surgery to remove the cancer. You may also have other treatments such as targeted therapy or immunotherapy.

Always tell your cancer doctor or breast care nurse about any treatment side effects you have. There are usually ways to control side effects. Your cancer doctor or breast care nurse will tell you about ways to help manage them.

Some treatments for breast cancer can affect whether you are able to start a pregnancy (your fertility). If this is important to you, talk to your doctor or nurse before you start your treatment. They can talk about how it may affect you and what your options are. There are drugs and other ways of preserving your fertility.

The type of surgery you have depends on:

• the size and position of the cancer
• your preference.

You and your breast surgeon will decide which operation is best for you. You may be asked to choose which operation you want to have.

Your surgeon will explain more about the type of surgery that is suitable for you. Some people choose to have a mastectomy instead of a WLE.

Breast reconstruction

If you are having a mastectomy, your surgeon may ask if you want a new breast shape made during the operation. This is called an immediate breast reconstruction. You can also choose to delay reconstruction until after your treatment.

Breast reconstruction is specialised surgery done by expert surgeons. There are different types of reconstruction available. Your cancer doctor or breast care nurse will talk to you about this.

Surgery to the lymph nodes

Your surgeon may remove some or all the lymph nodes in your armpit to check them for cancer cells. This can also:

• remove any lymph nodes that contain cancer cells
• give your doctor information about the stage of the cancer.

There are different types of lymph node biopsy. You may need more treatment if only some lymph nodes were removed.

Chemotherapy is an important treatment for triple negative breast cancer. This is because it is usually more effective against cancer cells that are faster growing (high grade). But you are usually offered chemotherapy even if triple negative breast cancer is low grade or has not spread to the lymph nodes in the armpit.

For breast cancer, you usually have chemotherapy after surgery. This is called adjuvant chemotherapy. You have it to reduce the chance of the cancer coming back. But you can have chemotherapy before surgery. This is called neo-adjuvant chemotherapy. If you have triple negative breast cancer, you are more likely to have chemotherapy before surgery.

Chemotherapy can cause side effects, but many of these can be well controlled. Side effects usually improve after treatment has finished.

Chemotherapy drugs

Triple negative breast cancer usually responds well to chemotherapy. Clinical trials try to find out more about the most effective drugs to use.

The chemotherapy drugs used to treat triple negative breast cancer include doxorubicin or epirubicin. You usually have 1 of these with docetaxel or paclitaxel. Your cancer doctor or breast care nurse will explain about the drugs that may be suitable for you. 

Carboplatin is also commonly used to treat triple negative breast cancer. It is often used in people with BRCA gene variants.

Capecitabine is sometimes used to treat triple negative breast cancer. A newer drug called nab-paclitaxel is also now being used. It is usually given with atezolizumab for triple negative breast cancer that has spread (metastatic).

Radiotherapy treats cancer using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. You usually have it after surgery and chemotherapy.

If you have had breast-conserving surgery, you will have radiotherapy to the remaining breast tissue. This reduces the risk of the cancer coming back in that area. If you have had a mastectomy, sometimes you may have radiotherapy to the chest area.

You usually have radiotherapy as a series of short daily treatments. Each treatment is called a fraction or a session. You usually have 5 sessions of radiotherapy over 1 week. Sometimes it is given as 15 sessions over 3 weeks. Your cancer doctor or nurse will tell you how many sessions you will need.

Radiotherapy to the breast can cause some side effects. These are usually mild. Your cancer doctor, nurse or radiographer will talk to you about how to manage these.

Immunotherapy drugs help the immune system recognise and destroy cancer cells. You usually have immunotherapy drugs as a drip into a vein (intravenously).

You may have the immunotherapy drug pembrolizumab (Keytruda^®) for early triple negative breast cancer. You may be offered this treatment with chemotherapy before surgery. This is called neo-adjuvant chemotherapy. You usually continue to have pembrolizumab on its own after surgery.

Atezolizumab (Tecentriq^®) is another immunotherapy drug you may have with chemotherapy. This is usually given for triple negative breast cancer that has spread (metastatic). Your cancer doctor may arrange tests on the cancer cells that were removed to check if this treatment is likely to work for you.

Your cancer doctor or nurse can tell you more about whether immunotherapy is suitable for you.

Targeted therapy drugs interfere with the way cancer cells grow.

Olaparib (Lynparza®) is a targeted drug that can work in cancer cells that have a change (mutation) in the BRCA gene.

Sacituzumab govitecan is a new targeted drug. It may be used to treat triple negative breast cancer that has spread (metastatic).

Your cancer doctor may talk to you about having treatment as part of a clinical trial. Clinical trials test new treatments or different combinations of treatment. This may include testing different combinations of chemotherapy, targeted and immunotherapy drugs, or anti-androgen drugs.

Androgens are hormones made in your body. Some triple negative breast cancers have androgen receptors on the surface of the cancer cells. These are called androgen positive.

Enzalutamide is an anti-androgen drug that has been used in a clinical trial for triple negative breast cancer. Your cancer doctor or nurse can tell you more about this.

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