VIDEO: Exploring treatment options in metastatic triple-negative breast cancer

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So the treatment options have expanded over the past few years. The cornerstone, however, remains chemotherapy. And chemotherapy has been traditionally the only agent that we use for triple negative breast cancer, the only type of treatment. And until today, it remains a very important component on the management of triple negative breast cancer. Now, chemotherapies are not created equal, just like your antibiotics. Every type of bug has its own little antibiotic that works best against it. And same goes for triple negative breast cancer. There's so many types of chemotherapy out there, but only a few of them are the ones that we use in this setting. And also their side effects vary and their efficacy varies. And typically the chemotherapies we use early on, and by early on, I mean the earlier lines of therapy, usually belong to groups like taxanes, carboplatinum, gemcitabine, capecitabine. And these are well-known agents. And typically these are the agents that are recommended in our NCCN guidelines. Over the past few years that arsenal have expanded. The FDA approvals for some of these. We have three FDA approvals. And first one was the introduction of immunotherapy, specifically pembrolizumab, in addition to a taxane or a carboplatin capecitabine. And I believe that approval is in 2021. And this is only applicable to patients who have positive immunotherapy sensitivity, what we call CPS score 10% or more. Another approval was the approval of sacituzumab govitecan or TRODELVY, which is an antibody-drug conjugate that is approved for the second or third line of therapy. And this drug is typically approved regardless of the subtype of triple negative breast cancer. So all patients are eligible for it. And the third approval, that I would say was the latest one is in HER2, which is approved an antibody-drug conjugate and approved for HER2-low which is a subtype of triple negative breast cancer. And again, it's an antibody-drug conjugate. These last two agents, antibody- drug conjugates, are fairly effective while maintaining safe and low level of side effect profile. They do have their own problems, they do have their own side effects, and it's always good to kind of have a in-depth conversation about pros and cons of each of those lines of therapy. Beyond the third line of treatment, typically that means that the third combination in which patients have been on as the cancer progressed. Things get a little bit murky, and there is no clear line of therapy or clear consensus about what is the best next step. There's always chemotherapy option, but which one to choose and gets a little bit of technical regarding patient's performance, how do you do, what side effects that they've experienced. And typically at that setting, it's almost always recommended to participate in clinical trials. It's usually recommended to participate from the get-go. However, once patients do progress in three different types of standard treatments, I think clinical trials almost always come to mind.