Is cryoablation (cryotherapy using low temperatures) a recommended treatment for triple-negative breast cancer?

Cryoablation in Triple-Negative Breast Cancer: Not Recommended as Standard Treatment

Cryoablation is not recommended as a standard treatment for triple-negative breast cancer (TNBC) based on current guidelines, which instead emphasize systemic chemotherapy, immunotherapy, and surgery as the primary treatment approaches. 1

Current Standard Treatment Recommendations for TNBC

First-Line Treatment Options

• For PD-L1-positive TNBC:

  • Immune checkpoint inhibitors (atezolizumab plus nab-paclitaxel or pembrolizumab plus chemotherapy) as first-line therapy 1

• For PD-L1-negative TNBC:

  • Single-agent chemotherapy is preferred over combination chemotherapy
  • Combination chemotherapy may be considered for symptomatic or immediately life-threatening disease 1
  • Both platinum-based and non-platinum-based regimens can be considered based on individual assessment 1

Second-Line and Beyond

• After at least two prior therapies: Sacituzumab govitecan is recommended 1
• For BRCA1/2 mutation carriers: PARP inhibitors (olaparib or talazoparib) are preferred over chemotherapy 1
• For BRCA-associated TNBC: Platinum regimens are preferred if not previously administered 1

Role of Cryoablation in TNBC

While cryoablation has emerged as a minimally invasive technique for treating certain breast cancers, current evidence does not support its use as a standard treatment for TNBC. The most recent research indicates:

• Cryoablation may have a role in palliative treatment of multicentric TNBC for specific objectives such as:

  • Pain relief (breast or nipple)
  • Prevention of tumor erosion through skin or nipple
  • Cases where patients have failed or cannot tolerate standard treatments 2

• The technique has been primarily investigated for early-stage, hormone receptor-positive, HER2-negative breast cancers rather than TNBC 2

Limitations and Considerations

• Current guidelines from ASCO (2021) and ESO-ESMO (2017) do not include cryoablation as a recommended treatment option for TNBC 1
• Available studies on cryoablation in breast cancer have small sample sizes, preventing definitive conclusions 3
• Many aspects of cryoablation remain to be elucidated, including:
  • Technical issues
  • Appropriate indications
  • Efficacy compared to standard treatments
  • Imaging follow-up protocols
  • Advantages over other percutaneous ablative methods 3

Clinical Decision-Making Algorithm

1. Determine PD-L1 status of the TNBC tumor
2. Test for germline BRCA1/2 mutations to guide treatment decisions 1
3. Assess disease burden and symptoms:
   • Extensive or life-threatening: Consider combination chemotherapy
   • Limited disease: Single-agent chemotherapy may be sufficient
4. Consider cryoablation only in these specific scenarios:
   • Palliative setting where standard treatments have failed
   • Patient has contraindications to surgery or systemic therapy
   • As part of a clinical trial

Future Directions

The future of TNBC treatment appears to lie in better biological characterization of this breast cancer subtype into further subgroups, followed by the development of specific therapies for each subgroup 1. Cryoablation may find its place in this landscape as research evolves, particularly given its potential immunological effects that could complement immunotherapy approaches 3.

While cryoablation shows promise as a minimally invasive option that may preserve breast aesthetics 4, it should currently be considered experimental for TNBC outside of palliative settings or clinical trials.