Fighting the Triple Negative Threat

Oct. 15, 2007— -- Karen Esposito was nursing her 7-month-old daughter last April when she felt pain in one breast. "I thought it was just a clogged milk duct, so I put a hot pad on it and didn't think much more about it," says Esposito, 35.

When the pain didn't subside, she began to feel around her breast and discovered a lump the size of a pea.

A mammogram showed nothing, but when doctors did an ultrasound of her breast, they saw the tell-tale tumor spreading tentacles out like a star. A biopsy a few days later confirmed the cancer, and told the type: the aggressive tumor was so-called triple negative, which bears none of the common hormone markers, and is difficult to treat.

"When I found out, I felt so scared," says Esposito. "It's hard not knowing what makes it grow."

She has now undergone a dose of chemo, a double mastectomy, and radiation therapy to treat the cancer. As opposed to other types of breast cancer, triple negative tumors have long been a mystery to oncologists.

New Treatments for Aggressive Tumors

Now, some doctors are trying to shed light on how this kind of cancer grows.

"Triple negative breast cancers are very distinctive, not in what they have but in what they lack," says Dr. Angela DeMichele, assistant professor of medicine at the Abramson Cancer Center of the University of Pennsylvania. She explains that these cancers, which account for 10 to 15 percent of all breast cancers, have peculiarities.

"One of the problems is that these tend to be more aggressive tumors, and they are more resistant to standard therapies," says DeMichele. "They also tend to attack younger women, [under 40 years old] African-American women, and are more often linked to a breast cancer gene mutation. Despite advances in treating other breast cancers, we are only just now starting to unravel the problems of this type of tumor."

Since these cancers move quickly are often caught later, they are difficult to treat and have a higher mortality rate than other breast cancers. DeMichele has designed a new clinical trial, the first of its kind in breast cancer, using new drugs to treat triple negative tumors.

The trial, which just started and will continue for two years with 36 patients, is testing the combination of two drugs, Abraxene and Avastin.

Abraxene functions in a way similar to other established cancer drugs, except it uses a protein called SPARC to sneak into cancer cells and stop them from reproducing. Avastin impacts the blood flow to the tumor, cutting off smaller blood vessels and keeping only the larger vessels that will help deliver the cancer-stopper Abraxene.

Together, DeMichele says, these drugs can improve treatment for women with triple negative tumors.

"It's important to remember, if we pick up breast cancers early, we've made great strides to improve the cure rate," she says. "But once it gets outside the breast and lymph tissue, the cancer is no longer curable -- and we're not anywhere near a cure. Then it becomes a chronic disease, and we're just keeping the cancer at bay. So there is a great need to find something that can really help."

Using special imaging techniques, Dr. DeMichele's team is able to "see" inside the body to determine if the drug treatment, which is administered through an IV drip three weeks out of four, is impacting the tumor's blood supply.

"This way, we won't have to keep the patient on the drugs for eight to 10 months if they aren't working for her," says DeMichele. "We can move on to other options if we see that the blood supply to the tumor is unchanged."

Clinical Trials Are Clutch

One of the challenges to DeMichele's research is finding women to participate in clinical trials, which she says is of vital importance.

"Participating can help others as well as offer patients the best and most specialized care in trials," she says. "We're not testing things that are unknown; we're tweaking treatments to make them even more effective for patients."

The future will hold better treatments to target specific breast cancers, according to DeMichele.

"The goal is to find treatments to eradicate the disease, not just control it," she says. "We're going to be able to test tumors for a whole range of proteins, and then can use non-invasive imaging to see how our treatments are working."

For Karen Esposito, one of her goals now is to impart the wisdom of her body to her friends, neighbors and cousins, by showing them how to do breast self-exams.

"It's scary how many women I knew don't do self-exams because they say they don't know what to look for," she says. "If I can tell women one thing, it's that you're never too young to get breast cancer."