What are the post-treatment protocols for triple-negative breast cancer, including medical therapies, such as chemotherapy and hormone therapy, and lifestyle changes?

From the Guidelines

Post-treatment care for triple-negative breast cancer should prioritize close monitoring, adjuvant therapies, and lifestyle modifications to minimize risk factors associated with cancer recurrence and improve quality of life. After completing primary treatment, patients should follow up with their oncologist every 3-4 months for the first 2-3 years, then every 6 months for years 3-5, and annually thereafter, as recommended by the American Cancer Society and American Society of Clinical Oncology 1.

Medical Therapies

Medical therapies may include:

• Adjuvant capecitabine for patients with residual disease after neoadjuvant chemotherapy, which has shown to improve disease-free survival.
• For patients with BRCA mutations, PARP inhibitors like olaparib (300mg twice daily) or talazoparib may be recommended for one year, as suggested by the ASCO guideline update 1.
• Immunotherapy with pembrolizumab may be used in high-risk cases.
• Sacituzumab govitecan may be offered to patients with triple-negative MBC who have received at least two prior therapies for MBC, as recommended by the ASCO guideline update 1.

Lifestyle Modifications

Lifestyle modifications are crucial and include:

• Maintaining a healthy weight through a diet rich in fruits, vegetables, and whole grains while limiting processed foods, alcohol (less than one drink daily), and red meat.
• Regular exercise (150 minutes of moderate activity weekly) has been shown to reduce recurrence risk by 40-50%, as suggested by the ESMO clinical practice guidelines 1.
• Stress management through meditation, yoga, or counseling helps improve quality of life and potentially immune function.
• Vitamin D supplementation (1000-2000 IU daily) may be beneficial, as deficiency has been linked to poorer outcomes.

Surveillance

Regular mammograms, breast MRIs, and blood tests are essential for surveillance, as recommended by the ESMO clinical practice guidelines 1 and the American Cancer Society and American Society of Clinical Oncology 1.

These interventions work together to reduce inflammation, improve immune function, and minimize risk factors associated with cancer recurrence, ultimately improving morbidity, mortality, and quality of life outcomes for patients with triple-negative breast cancer.

From the Research

Medical Therapies for Triple-Negative Breast Cancer

• Chemotherapy is the cornerstone of treatment for triple-negative breast cancer (TNBC), with sequential anthracycline- and taxane-based neoadjuvant chemotherapy (NACT) being the standard therapeutic approach for early-stage TNBC 2.
• Sacituzumab tirumotecan has demonstrated clinical benefits and is considered a standard therapy for metastatic TNBC, with a randomized phase 3 trial showing improved progression-free survival and overall survival compared to chemotherapy 3.
• Platinum compounds have been explored as an alternative or additional chemotherapy option for TNBC, with some studies suggesting potential benefits 4, 5.
• Immunotherapy, targeted therapy, and combination therapy are also being investigated as potential treatment options for TNBC 4, 5.

Lifestyle Changes for Triple-Negative Breast Cancer

• There is limited research on specific lifestyle changes for TNBC, but general healthy lifestyle recommendations may be beneficial for overall health and well-being.
• No specific studies were found that directly link lifestyle changes to improved outcomes for TNBC, but a healthy diet and regular exercise are generally recommended for cancer patients 2, 4, 6, 3, 5.

Future Directions for Triple-Negative Breast Cancer Treatment

• The application of multi-omics technologies, liquid biopsy assays, and machine learning algorithms may help guide treatment escalation and de-escalation, as well as the development of new therapies for TNBC 2.
• Nanotechnology has been suggested as a potential solution to the problem of suboptimal TNBC treatment, with further research needed to explore its potential benefits 4.
• Biomarkers such as tumor-infiltrating lymphocytes or BRCA may help identify patients who are more likely to respond to certain treatments, allowing for a more personalized treatment approach 5.