01/30/2021
I think 3 or 4 years ago i did a discussion on general breast cancer,today i will do a little presentation on mTNBC(metastatic triple negative breast cancer).mTNBC is a type of breast cancer that does not show any expression for ER,PR or HER2 markers from pharmacogenomic testing.It is not a very common type of breast cancer and is more prevalent in younger,obese,premopausal, and black women.It is also a more aggressive type of breast cancer and the metastatic involvement more targets the lung and brain tissue.the prognosis is poor and recurrence is more common and happens earlier than in other types of breast cancer.About 15% of patients have BRCA1/2 expressions and PD-L1 expression is a good indication that drug therapy will be effective.The goal of care and therapy is to extend life and improve quality of life.I will now go on to discuss treatment regimens for this kind of breast cancer.The factors influencing treatment decisions are tumor burden,rate of disease progression,performance status,previous treatment regimen and patient preference.The good thing about the treatment of this kind of breast cancer is that there are quite a few good options.Because hormone therapy and HER2 drugs are not choices for women with TNBC,chemotherapy is the therapy of choice.Common chemotherapy agents used are capecitabine(xeloda),gemcitabine,taxanes,anthracyclines and eribulin.with capecitabine and gemcitabine the adverse effects are myleosuppression therefore there will be bone marrow depression,mucositis which is sores in the mouth,dermatitis,diarrhea,cardiotoxicity,hand-foot syndrome which affects the palms and sole of the feet.Taxanes used are docetaxel and paclitaxel and the adverse effects are myleosuppression,peripheral neuropathy,nausea,vomiting,diarrhea,hepatotoxicity,mucocistis and alopecia.The anthracyclines are mainly associated with cardiotoxicity,alopecia,secondary AML OR MDS and impaired hepatic function and they have maximum lifetime doses.common side effects of eribulin is urinary tract infection,alopecia,severe neutropenia and diarrhea.For women with TNBC with BRCA1/2 mutation whose cancer stops responding to commonly used chemotherapy agents, platinum agents such as cisplatin and carboplatin can be used,or the targeted PARP inhibitors such as olaparib and talazoparib.Adverse effects of platinol agents include myleosuppresion and neuropathy.side effects of the PARP inhibitors include upper respiratory tract infection,vomiting,diarrhea,weakness,taste distortion,decreased appetite and headache.In advanced cases of TNBC that makes the PD-L1 protein these cases can be treated with atezolizumab with abraxane(albumin-bound paxlitaxel) or pemborlizumab with chemotherapy,this PD-L1 protenin is only found in about 20% of cases.for mTNBC in which at least 2 other treatments have been tried,then sacituzumab govitecan-hziy(trodelvy) may be an option.I will now take a little time to discuss how to manage some of the adverse effects of the chemotherapy agents.For hand foot syndrome it can be managed by elevating the feet and moisturizing the palms and soles of the feet,vitamin B6 may also help, also dose reduction or delay of dose.mucositis can be treated with magic mouth wash,saline or chlorhexidine.I do hope this discussion may be helpful to both professionals and non-professionals in understanding the management and treatment of mTNBC. acknowledgements to pharmacy times and rx prep.
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Yordis Morrison
Wow! Nicky I always look forward to you sharing in all things medical.
Keep it going...
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