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Q&A: New Treatment for Triple-Negative Breast Cancer

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Litton1a.jpgEarly findings from Phase I and Phase II clinical trials using a new class of drug to treat patients with triple-negative breast cancer are showing promising results. Known as poly (ADP-ribose) polymerase, or PARP inhibitors, these new agents received considerable attention at the American Society of Clinical Oncology meeting in June.

Cheryl Jolly, in the related story, is now enrolled in a Phase III trial, and her tumor is shrinking.

Jennifer Litton, M.D., assistant professor in MD Anderson's Department of Breast Medical Oncology, answers questions about this new drug and why it is helping women with this aggressive type of breast cancer.

Exactly what is triple-negative breast cancer?  
Triple-negative breast cancer is a subset of breast cancers that are not driven by estrogen or progesterone hormones. They also do not overexpress the HER-2/neu protein. Biologically, they are very aggressive and can grow more rapidly than other types of breast cancer.  

Can someone be genetically at high risk for developing it?  
Women who have been diagnosed with a BRCA1 deleterious (harmful) mutation as well as younger, premenopausal women and women of African-American descent, appear to have higher rates of developing triple-negative breast cancers, although triple-negative breast cancers can occur at any age and in any race. Women who are diagnosed premenopausally or have a family history of breast and/or ovarian cancers, especially at younger ages, should discuss with their oncologist whether or not they should meet with a genetic counselor.

What makes PARP a different type of treatment?
PARP inhibitors, such as olaparib and BSI-201, belong to a class of drugs that provide targeted therapy. They exploit a specific weakness in tumors stopping them from repairing damage in tumor DNA caused by chemotherapy. In addition, it also takes advantage of a further weakness, especially in tumors whose BRCA genes no longer work -- and causes that cell to die.

In a Phase II study of olaparib presented at the American Society of Clinical Oncology, women with BRCA1 or BRCA2 mutations and advanced breast cancer that persisted despite previous treatment, more than one-third of patients had tumor shrinkage.

BSI-201, in combination with conventional chemotherapy, significantly improved overall and progression-free survival in women with metastatic triple-negative breast cancer, compared with chemotherapy alone.

Why does it seem to work for women with triple-negative breast cancer?  
This therapy appears to take advantage of weaknesses commonly seen within a triple-negative breast cancer cell. Also, paired with the right chemotherapy, its activity may not be limited to only triple-negative breast cancers.


What are the side effects of this treatment? 
There are several PARP inhibitors currently in development. Some are pills while others are given intravenously. Although side effects differ from drug to drug, overall they are very well tolerated adding little extra toxicity to the accompanying chemotherapy.


What other cancers does it show promise for?  
Right now PARP inhibitors are also being considered for other cancers such ovarian, uterine, brain and prostate cancers. As more clinical trial data become available, more tumors may be impacted by this class of drugs.


Related story:
After Four Years of Bad News, Cautious Optimism for Breast Cancer
Despite a harrowing health crisis in the past four years, the Sugar Land, Texas, wife and mother of two young boys is quick to laugh about aspects of her extensive treatment for triple-negative metastatic breast cancer. Read Cheryl Jolly's Story


MD Anderson resources:
News Release - UT MD Anderson Study Finds Women with Both Triple Negative Breast Cancer and BRCA Mutations Have Lower Risk of Recurrence

Cancerwise blog posts by Jennifer Litton

Additional resource:
More information on PARP inhibitors (NCI)
http://www.cancer.gov/drugdictionary/ enter "PARP" into the Search box

10 Comments

I was diagnosed with triple negative cancer last May. I had a partial mastectomy, followed with chemo and 33 treatments of radiation. I'm very concerned with a relapse or cancer coming back somewhere else. Do you have any clinical trials for people with triple negative and my cancer markers CEA and CA2729 are elevated.? I am 58 years old and good health.

Hi Paula, unfortunately we cannot give specific treatment recommendations through this correspondence. Please contact ask MD Anderson at 1-877-MDA-6789. Our Health Information Specialists can help identify clinical trials and treatment options for your specific case.

hello paula i hope you are doing okay, my daughters best friend has triple negative breast cancer as well. I just found this website cancer center moon shots. and was trying to maybe find her a clinical trial as well. like you were back in september of 2012. My daughters friend Randa has had a double mastectomy and all her lymph nodes removed on one side. She is experiencing some lyphedema. She started radiation but has had to stop because 3 more tumors have been found. Very large and they hurt her. This is all very upsetting and i have no right to be upset because its not happening to me. Randa is 30 and i know you may not want to answer the question but i would just like to know if you found any clinical trials concerning these inhibitors. I cant find any answers to really anything. Now this is changing the subject but i read recently Taking large doses of vitamin D like 4,000 units a day can halt the spread of tumors. Im very deficient in vitamin d myself and take 2,000 units a day. The tumors mutate because the tumor itself has vitamin d receptors.
So when you take vitamin d it mutates some how and they start to die? or shrink. somehow it works. Okay i hope you dont mind my invasion in your privacy. But I wish you the best! Paula Kuras.

Hi, we're sorry to hear about your daughter's friend. Unfortunately we cannot give treatment recommendations or provide second opinions through this correspondence. We suggest you contact our Health Information Specialists at Ask MD Anderson by calling 1-877-MDA-6789 or visiting them online at http://www.mdanderson.org/contact-us/askmdanderson/index.html. Our knowledgeable staff will listen to your questions and help you make decisions about your care. Best wishes!

Can a PARP inhibitor be given if someone is already on chemo or must other chemo be stopped?

We live in Jacksonville and if I make an appointment for my wife, can she be seen in Orlando or do we go to Houston? Also, can any changes MDA recommends be implemented and continued by her local oncologist in Jacksonville?

Every case is different. It's best to talk to your doctor about this.

As of Feb. 1, 2014, MD Anderson is no longer affiliated with Orlando Health. After working together for more than 23 years to accomplish their joint goal of raising the quality of cancer care in Central Florida, Orlando Health and The University of Texas MD Anderson Cancer Center in Houston decided not to renew their business relationship when the contract expires. Please call 1-877-632-6789 to learn about our other locations and partnerships.

My wife was diagnosed with Triple negative breast cancer in 2013. After Chemo, radiation and surgery, it metastasized to the bone in 2014. She is in a clinical trial for Verastem VS-5584 at Cedar Sinai in Los Angeles, where we live. It has been 4 weeks. I don't see an improvement, and perhaps a deterioration in her condition. I would like to share her medical records with someone experienced in this type of cancer and who can help. Time is of the essence. Thank you

Hi Chris, please call 1-877-632-6789 to speak to an MD Anderson health information specialist. They can help answer your questions and help you schedule an appointment. Your wife is in our thoughts and prayers.

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