The TNBC Treatments Nobody's Talking About (But Should Be) #CancerTreatment

Triple Negative Breast Cancer: Emerging therapies doctors don’t always mention.

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Episode Description:

If you’ve been told triple negative breast cancer means limited options…

That it’s mostly just chemotherapy…

That’s not the full picture.

There are treatment paths that often aren’t discussed—and they depend on details most people never get tested for.

• TNBC isn’t one disease—it varies more than you think
 • Some tumors still have targetable features (even if they’re “negative”)
 • Certain mutations can actually be turned into treatment advantages
 • Some effective therapies aren’t routinely offered or even mentioned

These gaps can quietly shape your entire treatment plan.

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info@elevatingcancertreatment.com

https://elevatingcancertreatment.com

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Disclaimer:
The information provided in this podcast is for educational and informational purposes only, and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard or read in this podcast or on this channel.
Reliance on any information provided by Dr. Jay Chaplin or Elevating Cancer Treatment is solely at your own risk. Dr. Jay Chaplin is a scientist and drug developer, not a medical doctor providing patient care. The content presented here reflects general scientific understanding and research, and may not be applicable to your individual health circumstances. Individual medical conditions and treatments vary, and no two situations are exactly alike.
Always consult with your personal healthcare provider before making any decisions about your health or treatment plan.

Transcript

SPEAKER_00 0:00

So this episode is a little different. It's the beginning of Breast Cancer Awareness Month, and I want to talk about triple negative breast cancer because it's largely been left behind, or at least that's how it's perceived. There are a lot of options available, and this episode is going to be about some of those options that doctors and clinicians may not be aware of. This episode is going to be more technical, so please don't worry if you struggle a bit. This may be information to take to your doctor, to your medical advocate, or to have deeper conversations with me about. However, this is to let you know that if you or a loved one have triple negative breast cancer, there are many options that have come about in the last decade that many doctors are not fully aware of. We'll go into most of those today. Hello and welcome to Elevating Cancer Treatment, where we explain the science and debunk common myths to help you navigate your health journey. My background is different. Beyond educating about cancer, I'm crafting new and innovative drugs that are defining the future of oncology. This direct hands-on experience offers me a different perspective than most people on the internet about how your cancer therapy's molecular mechanisms work and how they interact with your body. And that's an insight that I'm excited to share with you. If that sounds interesting, make sure to like this video, subscribe to the channel, and hit that notification bell so you never miss an update. I'm Dr. Jay Chaplin. A quick reminder, I'm a PhD, not an MD. The information in this video is about drugs and cancer biology and how those interact. And it's education. It shouldn't be taken as medical advice. Every cancer is unique and no general information applies to everyone. Always consult with your personal healthcare team for guidance on your specific situation. Also, two quick things. First, as a thank you for being here, I've created a free resource, 10 things to elevate your chemo journey. That can be downloaded from the link down below in the description. Also, by signing up for that, you'll get updates on the startup that we're forming and the immunotherapy drugs that I've designed. So take a moment, download your free guide, and join us in shaping the future of oncology and cancer treatment. As I record this, it's early October. This is breast cancer awareness month, and one thing that I am very, very aware of is how far we've come in general on breast cancer. Since 1998, when tamoxifen and her septin were approved and started use, we have had a 44% increase in the survival rate of breast cancer. Unfortunately, what kind of gets left behind in that is what we call triple negative breast cancer or TNBC. Because triple negative breast cancer doesn't express the estrogen receptor, which is targeted by tamoxifen, or the progesterone receptor. It also doesn't overexpress her 2, the target of her septin. Because of that, since those are the mainstays of breast cancer treatment these days, triple negative breast cancer has sort of been relegated and often it just gets standard chemo, and there's nothing special we can do for it. And that is not true. Your clinician may not be aware of it, but there are multiple therapies approved specifically for triple negative breast cancer. Some that have proved to be effective but are off label, we'll talk about that in a bit, and others that are coming up through clinical trials right now. You can get into clinical trials for those, or hopefully by the time you're seeing this, they've already been approved. Just know that there are treatments for triple negative breast cancer specifically, and your doctor should know about these. If your doctor doesn't, take the resources listed down below, take them to your medical team, and expand your option set. Now, triple negative breast cancer isn't a thing, just the way breast cancer isn't a thing, just the way that cancer isn't a thing. There are many different flavors of triple negative breast cancer. Because there's a tremendous amount of variation within triple negative breast cancer or TNBC, don't stop with just a diagnosis of TNBC. Go for further biomarkers. It's incredibly helpful. There are less well-known targeted therapy options for TNBC that your doctor may not be aware of, but you can exploit. So, for instance, you can ask for a more detailed determination of HER2 expression. So only tumors that massively overexpress HER2 are good targets for Herceptin treatment. However, many tumors that don't overexpress still express the regular amounts of HER2, or maybe even less, but still some. And those are called HER2 low or ultra-low. Now, these are still targets for something called antibody drug conjugates. And that's where you take something incredibly poisonous, an incredibly poisonous molecule, and you attach it to an antibody that selectively delivers it to the cancer. In this case, it's the same antibody, Herceptin. Now, there may not be enough HER2 protein on the surface of the tumor for the antibody itself to make a difference, but with a poison attached, it can kill those cells and significantly improve your treatment odds. Now, there's a similar ADC or antibody drug conjugate against a different protein that's often expressed on triple-negative breast cancer. That one is called TROP2, TROP2. That's useful in many TNBC cases. Now, I won't even attempt to pronounce the names for those two ADC drugs. They're horrible even for me, and I'm used to this kind of thing. But they're in the links that are down in the description. Another option is for people who have BRCA1 and BRCA2 mutations. Now, those are the ones that mess up DNA repair and allow mutations to happen much more rapidly. This is normally seen as an incredibly bad thing. However, there's a class of drugs called PARP inhibitors, P-A-R-P, PARP inhibitors, that can be very helpful with those mutations, especially when they're combined with the drugs 5-azocitidine and delcitabine. This turns a genetic weakness into a treatment option. PARP inhibitors were just approved in 2018. I know that's seven years ago, but continuing medical education isn't the greatest, so some clinicians haven't fully integrated those yet. They are fantastic. Now, some triple-negative breast cancer cases will express EGFR, the epidermal growth factor receptor, instead of HER2. And in that case, EGFR fills the same function of making the cells overgrow. In those cases, off-label use of EGFR blockers have been very successful. So see if you can get biomarker evaluation for EGFR. Similarly, in about 30% of TNBC cases, instead of expressing the progesterone or estrogen receptors, they'll express an androgen receptor or a male sex hormone receptor, and that takes the place of the estrogen or progesterone receptors, and it'll cause the overgrowth. In those cases, an androgen blocker, like bicolutamide or enzalutamide, have proven to be very effective, especially in combination with those PARP inhibitors I mentioned before. These androgen blockers aren't licensed for breast cancer, they're licensed for prostate cancer, and you may not be able to get insurance to cover it, but it's been very effective if your androgen receptor positive. Cyclin-dependent kinase inhibitors, or CDK4-6 inhibitors, have also been shown to suppress triple-negative breast cancer progression, especially in combination with other drugs. They stop the ability of the cancer to divide and proliferate. So, in terms of what's coming into the clinic, there are several signaling pathway inhibitors in clinical trials right now. These are drugs that block the growth signal once it's already gotten to the cell. They block the PI3 kinase, AKT, and mTOR pathways, and they've been very successful in the lab. They're progressing rapidly through trials because they change the metabolism of the cancer. Dovaninimib and Pontanib are very successful with FGFR, fibroblast growth factor receptor overexpression. There's also a drug targeting mTOR, Everlimus, that's available. All of those, again, are off-label use and may not be covered by insurance, but they have solid clinical data. You can find a way. They're good drugs, you can find a way. Now, angiogenesis inhibitors like evastin are commonly prescribed since clinicians understand them and they sort of use them when they don't know what else to use. But they do very little to help. Trying to keep blood vessels from growing in doesn't seem to make a difference. Instead, immune checkpoint inhibitors or ICIs, a kind of immunotherapy, has been very successful, especially in combination with drugs that stress the tumor. They also have significant side effects, and you have to have the right kind of tumor, particularly PDL1 high. So, importantly, recent research shows that excessive removal of lymph nodes near the tumor, A, doesn't benefit survival rates the way people thought it did, and B, can undercut the effectiveness of immune checkpoint inhibition immunotherapies. So I I want to specifically address this to you. If you've already had the surgery, if those lymph nodes have already been removed, please don't stress, everything is okay. It's not a huge issue. If you haven't had surgery yet and you're thinking about having immune checkpoint inhibition therapy, if that's something your doctor has talked to you about, please ask them to do sentinel node biopsy and only take the minimum number of nodes possible. It does seem like that is A, easier on the body, and B more effective for those treatments. Try it out. Ask. You'll never get anywhere without asking. So remember, just because some of these treatments aren't widely known doesn't mean that they haven't proven useful. Pull the review papers from the description below and take them to your medical team to expand your options. Navigating a cancer diagnosis can be overwhelming. But armed with detailed and accurate information, you can make informed decisions and advocate for the best possible care for you or your loved one. Beyond these videos, if you need more personalized guidance or a deeper dive into specific treatments to have your treatment be as effective as possible, I offer one-on-one sessions and medical advocacy. I'm also currently in the process of developing an exclusive video series that breaks down each cancer treatment and drug in detail, along with interferences, things to avoid, ways to minimize side effects, and ways to maximize efficacy. You can find information on both of these resources on our website, again, linked down below. If you found this video informative, please give it a thumbs up, share it with others who might benefit, subscribe to our channel, and hit that notification bell for more science-based cancer insights. A channel like this only really works if it's delivering content that's important to you. The way that we do that is by looking at what's down in the comment section. Please, if you're willing, share with us things that you learned in your journey. What surprised you? What did you wish you had known earlier? What questions do you still have? Bring us all of that. Please let us know. That way we can deliver what you're most interested in and what will cause the most value for you. Thank you for your trust. Thank you for your patience. Really appreciate you being here, and I'll see you in the next episode.