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So let’s talk about triple negative breast cancer, which means that those three receptors that we talked about previously, those are all negative. So for triple negative breast cancer, it does tend to be a more aggressive form of breast cancer. This is also the breast cancer that’s generally associated with those BRCA or BRCA mutations. So for triple negative breast cancer, because it tends to be more aggressive, we generally do tend to do more neoadjuvant chemotherapy, which, again, means chemotherapy prior to surgery. Now that’s a benefit because when patients get neoadjuvant treatment, it tells us a couple of things on that final pathology. So when the breast surgeon and the medical oncologist get back that pathology specimen from your surgery, it tells us what kind of response your tumor had to the chemo, which can help us with first of all, prognosis.
And secondly, if you haven’t had a full or complete response to the chemotherapy, it also allows us the possibility of doing more chemotherapy after your surgery. Again, that’s called adjuvant treatment. So patients who have a complete response, that means that they have a complete pathologic response. So when the pathologist is looking at your tumor after your surgery, it generally looks like that chemotherapy has killed all of those breast cancer cells. Patients who have a complete pathologic response generally do have a lower chance of that breast cancer coming back in the future. For patients who get upfront surgery, so those patients who have small tumors and appear to have node negative disease, those patients should still generally have chemotherapy if their tumor is greater than 0.5 or half a centimeter, or certainly if those patients have any evidence of nodal disease, meaning cancer in their lymph nodes on their final pathology. So if you’re a patient who had breast cancer and you underwent upfront surgery, meaning you hadn’t had chemotherapy or other treatment prior to your surgery, if you’re noted to have lymph node involvement, meaning cancer in the lymph nodes on your surgery, for the most part, all of those patients need some form of chemotherapy.
In addition, if it’s HER2 positive, HER2 medication after your surgery. Really with hormone positive breast cancer, if it’s just hormone positive and very limited nodal disease, you may have a discussion with your medical oncologist about if IV chemotherapy as needed.
