Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer

Behind The Knife: The Surgery Podcast

A young woman is referred urgently to your breast surgical oncology clinic for a second opinion. She has been told that she needs to have an urgent mastectomy for a palpable triple negative breast cancer with suspicious axillary lymphadenopathy. Are there other options she should consider? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the multidisciplinary management of a patient with triple negative breast cancer.

In this episode, we review the diagnosis and classification of triple negative breast cancer, its biologic implications, surgical management including the role of sentinel lymph node biopsy vs axillary dissection, and the role of targeted chemotherapy including the recent FDA approval of immunotherapy for triple negative breast cancer in the neoadjuvant setting and indication for adjuvant chemotherapy for patients with residual disease following neoadjuvant therapy.

Links:
Enhanced recurrence and survival benefit of adjuvant chemotherapy for hormone receptor negative breast cancer compared to hormone receptor positive breast cancer
Berry et al (2006). Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA; 295(14): 1658-1667.

https://jamanetwork.com/journals/jama/fullarticle/202666

Neoadjuvant pembrolizumab for triple negative breast cancer
Schmid et al (2020). Pembrolizumab for early triple negative breast cancer. New England J of Medicine; 382(9): 810-821.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1910549?articleTools=true

ACOSOG 1071: Sentinel lymph node biopsy for patients who received neoadjuvant chemotherapy
Boughey at al (2013). Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG 1071 (Alliance) clinical trial. JAMA; 310(14): 1455-1461.

https://jamanetwork.com/journals/jama/fullarticle/1748149

Adjuvant capecitabine for triple negative breast cancer patients with residual disease following neoadjuvant chemotherapy:
Masuda et al (2017). Adjuvant capecitabine for breast cancer after preoperative chemotherapy. New England J of Medicine; 376(22): 2147-2159.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1612645?articleTools=true
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