Treatment Sequence for Triple-Negative Breast Cancer

In In The News by Barbara Jacoby

By: Dr. Elizabeth Comen


  • Triple-negative breast cancer is an aggressive form of the disease but it often responds well to chemotherapy
  • It is important to discuss the use of neoadjuvant therapy (chemotherapy before surgery) with your doctor, as it may be able to shrink the tumor prior to having surgery
  • Adjuvant (chemotherapy after surgery) may or may not be needed after surgery
  • Some patients who receive chemotherapy before surgery may also need additional chemotherapy after surgery.

triple-negative breast cancer diagnosis is an aggressive form of the disease, but it’s very treatable. Accounting for about  20 percent of all breast cancers, it’s called triple-negative because it does not have any of the main drivers of breast cancer—the estrogen receptor, the progesterone receptor, and the HER2 receptor—and doesn’t respond to the currently available treatments that target them.

The good thing about triple-negative breast cancer is that it often responds really well to chemotherapy. Early stage of this disease can be stages 1, 2, or 3, and this means that it is confined to the breast and/or lymph nodes that are located right under the arm. “Our primary line of attack is chemotherapy, and this is regardless of the cancer stage,” says Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Institute in New York.

Questions to Ask

Dr. Comen points out that when discussing treatment with your doctor, you should ask if you will be receiving chemotherapy before you have surgery. This is called neoadjuvant therapy.

The purpose of neoadjuvant therapy is to try to shrink the tumor before the main treatment is given, which in the case of breast cancer, is usually surgery.

In some cases your doctor might recommend chemotherapy after surgery, and that’s known as adjuvant  therapy. This is additional cancer treatment given after surgery, if there are still cancer cells present, or it might be given to lower the risk that the cancer will come back.

“If women have a lymph node involved or the tumor is very large, we will very often do chemotherapy upfront,” says Dr. Comen. “It is very important to know about this strategy for two reasons.”

The first is that having neoadjuvant chemotherapy may be able to shrink the tumor and make it easier to operate, and the second reason is that it can also tell the doctor whether you will need additional treatment after you have surgery. Some patients with triple-negative breast cancer may also need radiation after surgery.

“And what I mean by that, is if you have had chemotherapy before surgery, the pathologist will look at the tumor that is removed,” says Dr. Comen. “What we may find is that the tumor is gone. There will be a tumor bed, but the cancer itself is gone and that is what is called a pathologic complete response.”

But if you didn’t achieve a complete response, in addition to radiation, you may benefit from additional chemotherapy after surgery. The drug that is generally prescribed is called Xeloda; it is a chemotherapy medicine that is taken orally. “It’s very well tolerated and usually doesn’t involve hair loss and it can improve outcomes for women who still need treatment after surgery,” says Dr. Comen.