VIDEO: Challenges of treating metastatic triple-negative breast cancer vs. other breast cancers

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As breast cancer clinicians, metastatic triple-negative breast cancer is definitely the most challenging one that we face. And, I would say part of it is because obviously, anyone who treats metastatic triple-negative breast cancer treats all subtypes of breast cancer is you never get this response rate that you can get with HER2-positive breast cancers. And then you also don't get the duration of response as you can with both HER2-positive breast cancers. And as you can see with estrogen positive, HER2-negative breast cancers. And then finally, most of the treatments are a lot more toxic that we give for metastatic triple-negative breast cancer. You know, estrogen positive, HER2-negative breast cancer, you have all these oral medications we can give people. HER2-positive breast cancers have all this antibody therapy that we can give people. And even though, yes, we do have antibody drug conjugates that we can use for metastatic triple-negative breast cancers. You know, sacituzumab is not the easiest drug in the world. Trastuzumab deruxtecan can be better tolerated than sacituzumab from the patient standpoint. But then, there is the risk of interstitial pneumonitis. So, I would say treatment response, treatment duration, and then also, side effects of treatment really set metastatic triple-negative breast cancers apart.

And then finally, it's also not as satisfying that you don't have a target that you can focus on the way that you do with HER2-positive or hormone receptor-positive breast cancers. I would say finally, what's always been challenging is when you have the short duration of response, you really can go through quite a few therapies for a short period of time. And then, it really is the search for novel therapies. For, again, HER2-positive or hormone receptor-positive cancers, you have so many different ways to attack a certain pathway. The other advantage of hormone receptor-positive cancers is that there are other additional medications that can be combined with hormonal therapy that target specific mutations and the tumor, such as PI3 three kinase mutation, or else the mTOR P10 AKT pathway, or ESR1 mutations. So, these are other agents that give us other ways that we know will be targeted to the person's cancer rather than giving more generic chemotherapies, which even though, yes, they are effective, it often is not as satisfying both of the patient and provider in the sense that you're not giving something that you know is directly targeted for that person's cancer.