The Fellow on Call: The Heme/Onc Podcast Episode 064: Breast Cancer Series, Pt. 9-Triple Negative, Early Stage Breast Cancer
Jul 13, 2023
Dive into the complexities of triple-negative breast cancer (TNBC) and discover what differentiates it from other subtypes. Learn about the significance of neoadjuvant therapy and the intricacies of pathologic complete response versus residual cancer burden. Explore the latest trial data, including KEYNOTE-522, and the implications for treatment in patients with residual disease. The discussion includes practical decision-making tips for BRCA-positive patients, along with insights on chemotherapy regimens and evolving treatment algorithms.
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TNBC Is Biologically Aggressive Yet Chemo‑Responsive
- Triple negative breast cancer (TNBC) is heterogeneous, more chemo-responsive, and has earlier recurrences than other subtypes.
- Three-year overall survival is ~75% vs 90% for non-TNBC, and BRCA testing is recommended if age <60.
Verify Pathology Criteria For TNBC
- Confirm triple negative status by IHC: ER/PR <1% and HER2 IHC 0–1+ or IHC 2+ with negative FISH.
- Always review the pathology report carefully to interpret receptor status correctly.
pCR Is Prognostic But Not A Perfect Surrogate
- Pathologic complete response (pCR) predicts better long-term outcomes but is not a validated trial-level surrogate for survival.
- Residual Cancer Burden (RCB 0–3) refines prognosis, with RCB0/1 favorable and RCB2/3 worse.