Treating triple negative
breast cancer

It’s important to remember that we’re all unique and every case of TNBC is different. Your medical care team will work with you to come up with a plan that makes sense for you based on factors including:1

• The size of your tumour
• Whether or not your cancer has spread to surrounding tissues and/or outside your breast
• Your overall health history, and more.1

Some of the treatments used for other types of breast cancer are not helpful in treating TNBC. If you have been diagnosed with TNBC, talk with your doctor about your treatment options. Use our helpful patient discussion guide to feel empowered and get the most out of your conversations with your medical care team.

References

References:

1. Cancer Australia. Treatment options. [Accessed 6/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment

How are stages I-III triple negative breast cancer treated?

For early-stage TNBC (stages 1-3), the primary goal is to remove the cancer and reduce the risk of it coming back (recurrence).1-3 The standard treatment approach may involve a combination of the following: Chemotherapy Drugs given to kill the cancer cells and stop the cancer growing. It can be used before or after surgery.1-3
  • Before (pre-)surgery: Also called neoadjuvant chemotherapy, it is used to shrink the tumour to make it easier to remove and to provide early information about the tumour’s response to treatment.
  • After (post-)surgery: Also called adjuvant chemotherapy, is also used to target any remaining cancer cells.

Highly recommended resource about clinical trials.

The neoadjuvant patient decision aid, developed by Breast Cancer Trials, is an online tool (or downloadable booklet) for women recently diagnosed with early-stage breast cancer. It will help you understand your options and make shared decisions with your healthcare team. It is suitable for women with TNBC.
Download it here
Surgery Depending on the tumour size and location, surgery may involve breast conserving surgery or a mastectomy (removal of the entire breast). The decision between these surgeries depends on several factors, including patient preference and the specific characteristics of the tumour. One or more lymph nodes from under the arm are usually removed at the same time.1,2
  • Breast conserving surgery: It may be an option to have a lumpectomy, also known as a wide local excision or partial mastectomy – this is where the cancer and a small area around it are cut out.
  • Mastectomy: This is removal of the whole breast. The decision between these surgeries depends on several factors, including patient preference and the specific characteristics of the tumour.
  • Lymph node removal: One or more lymph nodes from under the arm (the axilla) are usually removed at the same time. If just one, it’s called a sentinel node biopsy. If all lymph nodes are removed, it’s called an axillary clearance. This may result in a complication known as lymphoedema.

Highly recommended resource about clinical trials.

BRECONDA is a decision aid developed in Australia, to help you decide, along with your surgeon, whether breast reconstruction is right for you after mastectomy.
You can find it here

Radiation therapy (or radiotherapy)
X-rays are used to kill cancer cell that may be left after surgery. For early breast cancer, it is almost always recommended after breast conserving surgery. It is sometimes recommended after mastectomy.1,2

Immunotherapy
Immunotherapy helps boost your immune system so that it can better recognise and destroy cancer cells. It does this by targeting specific immune system proteins. Drugs that target the PD-L1 protein may be added to chemotherapy in people with TNBC to improve outcomes.4

Targeted therapy
Targeted therapy such as “antibody-drug conjugates” help identify and deliver drugs to directly attack cancer cells and reduce damage to normal cells. PARP (Poly (ADP-Ribose) Polymerase enzymes) inhibitors are targeted therapies that can destroy cancer cells that are not good at repairing DNA damage.1-3

Hormone (or endocrine) therapy
Hormonal therapy is not usually effective in TNBC because the receptors are missing but may be used in some cases.1,3

Complementary therapies
Complementary therapies, such as acupuncture and massage may also be used to help manage the effects of cancer and its treatments.5 You may want to explore options to be involved in a clinical trial.2

Click here for more information about treatments for early TNBC.

Watch BCNA’s “Ask the Expert: Triple Negative Early Breast Cancer with Dr Nick Zdenkowski” here.

References

References:

1. Cancer Australia. Treatment options for early breast cancer. [Accessed 8/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/early-breast-cancer
2. Cancer Council Australia. Breast cancer – Your guide to best cancer care. [Accessed 8/9/2024]. Available at: https://cancer.org.au/cancercareguides/breast-cancer
3. American Cancer Society. Treatment of Triple-negative Breast Cancer. [Accessed 8/9/2024]. Available at: https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-triple-negative.html
4. Breast Cancer Network Australia. Immunotherapy. [Accessed 8/9/2024]. Available at: https://www.bcna.org.au/resource-hub/articles/immunotherapy/
5. Cancer Australia. Complementary and alternative therapies. [Accessed 8/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/complementary-and-alternative-therapies

What is recurrent
triple negative breast cancer?

Recurrent triple negative breast cancer (TNBC) is cancer that has come back (recurred), usually after a period of time during which the cancer could not be detected.1 The cancer may come back to the same place (locally) as the original (primary) tumour or to another place in the body (sometimes called distant recurrence).1

What can I do to prevent recurrence?
It is not possible to predict if TNBC will recur in an individual or why breast cancer comes back in some women but not in others.1

There are factors which may increase the risk of recurrence related to characteristics, such as age, tumour characteristics such as the aggressiveness of the tumour, or extent of the spread of cancer at diagnosis.1

Physical activity has been shown to decrease the risk of recurrence of breast cancer and reduce risk of death from breast cancer.1

What are my options if TNBC does recur?
If TNBC recurs locally and cannot be removed with surgery, adding immunotherapy and chemotherapy may be an option. Other treatments might be options as well, depending on your situation.2

If the cancer recurs in other parts of the body, options might include chemotherapy or an antibody-drug conjugate.2

Ask your doctor about all the treatment options that might be available for you.

References

References:

1. Cancer Australia. Recurrent and metastatic cancer. [Accessed 13/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/recurrent-and-secondary-cancer
2. American Cancer Society. Treatment of Triple-negative Breast Cancer. [Accessed 13/9/2024]. Available at: https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-triple-negative.html

How is metastatic triple negative breast cancer managed?

When triple negative breast cancer (TNBC) reaches Stage IV, it has spread beyond the breast and nearby lymph nodes to other parts of the body. The treatment focus shifts to controlling the disease, managing symptoms, and improving your quality of life. Treatment often continues until the cancer starts growing again or until side effects become unacceptable.1 If this happens, other drugs might be tried.2

Chemotherapy

Chemotherapy is the main treatment for metastatic TNBC. It aims to control cancer growth and manage your symptoms. Various chemotherapy regimens may be used depending on your previous treatments and overall health.1

Immunotherapy

Immunotherapy helps boost your immune system so that it can better recognise and destroy cancer cells. It does this by targeting specific immune system proteins. Drugs that target the PD-L1 protein may be added to chemotherapy in people with TNBC to improve outcomes.2

Targeted Therapy

Targeted therapy such as “antibody-drug conjugates” (ADC) help identify and deliver drugs to directly attack cancer cells and reduce damage to normal cells.2

Palliative Care

Palliative care is an essential component of treatment for metastatic TNBC. It focusses on symptom relief, pain management, and maintaining your quality of life. Palliative care is combined with ongoing cancer treatment to address all your care needs.1

You can find more information about Palliative care from Cancer Australia here.
BCNA’s Hope & Hurdles Information Guide includes a comprehensive booklet with information specific to metastatic triple negative breast cancer. Download it here.

What treatments are available to help with symptoms or complications from the cancer?

Although medications are the main treatment for stage IV breast cancer, other treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat cancer in a specific part of your body but are very unlikely to get rid of all the cancer. They are more likely to be used to help prevent or treat symptoms or complications from the cancer.3 Situations where these other treatments might be an option3:
  • When the breast tumour is causing an open or painful wound in the breast (or chest).
  • To treat a small number of metastases in a certain area, such as the brain.
  • To help prevent or treat bone fractures.
  • When cancer is pressing on the spinal cord.
  • To treat a blood vessel blockage in the liver.
  • To provide relief of pain or other symptoms anywhere in your body.
If your doctor recommends any of these types of treatments, it is important that you understand the goal—whether it is to try to cure the cancer or to prevent or treat symptoms.
References

References:

1. Cancer Australia. Treatment options for metastatic breast cancer. [Accessed 11/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/metastatic-breast-cancer
2. American Cancer Society. Treatment of Triple-negative Breast Cancer. [Accessed 11/9/2024]. Available at: https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-triple-negative.html
3. American Cancer Society. Treatment of Stage IV (Metastatic) Breast Cancer. [Accessed 11/9/2024]. Available at: https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-iv-advanced-breast-cancer.html

How do I manage symptoms and side effects (or complications) of triple negative breast cancer and its treatments?

Metastatic breast cancer affects different people in different ways. The symptoms you experience will vary according to which parts of your body are affected. Some symptoms may be the result of the cancer or its treatment. Others may be caused by other illnesses or medical conditions.

Cancer Australia provides information to help manage pain, and the physical side effects of metastatic breast cancer and its treatment. You can find it here: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes-metastatic-breast-cancer

They also provide guidance on how to manage the emotional impacts of metastatic breast cancer. You can find it here: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/emotional-changes-metastatic

Cancer Council Australia provides information about common cancer treatment side effects with downloadable brochures. You can find them here: https://cancer.org.au/cancer-information/cancer-side-effects

When is it time to stop treatment for triple negative breast cancer?

Living with metastatic TNBC may involve many different treatments, often over several years. In later stages, the cancer may spread more widely, and treatments may become less effective.1

Even when treatments stop working, pain and symptom control and support palliative care is available to make you as comfortable as possible.2

Deciding to stop treatment doesn’t mean giving up hope. Everyone will find hope in their own way – whether it’s about spending time with family and friends, finishing something that is important to you, or thoughts about an afterlife.1

The decision to stop treatment is a difficult one to make. It’s important you and your family get as much information as possible from your treatment team to reassess whether the possible benefits outweigh the side effects and impact on your quality of life. Ultimately, the decision to stop cancer treatment is your decision. Family members or partners may not want this to happen. Ask them about any concerns they have.1

You can talk to your doctor, counsellor or a psychologist about any concerns you or your family have.1

Cancer Australia provides information for women with advanced breast cancer about stopping treatment, facing the possibility of dying, putting your affairs in order and questions to ask. You can find it here: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/advanced-disease

Advance Care Planning Australia provides information and tools to help you plan for your future health care. It enables you to make some decisions now about the health care you would or would not like to receive if you were no longer able to communicate your preferences or make treatment decisions. You can find it here: https://www.advancecareplanning.org.au

References

References:
1. Cancer Australia. Advanced disease. [Accessed 11/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/advanced-disease
2. Cancer Australia. Palliative care. [Accessed 11/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/palliative-care-metastatic-breast-cancer

What are complementary therapies?

Complementary therapies can help you manage the effects of cancer and its treatments. They can be used alongside conventional medical care.1,2

Complementary therapies include relaxation, talking therapies, meditation, visualisation, acupuncture, aromatherapy, reflexology, music therapy, art therapy and massage.1,2

Some complementary therapies may not be recommended during your treatment as they interfere with your treatment and/or worsen side effects. Always talk to your doctor before starting any complementary therapy.2

What is the difference between complementary therapies and alternative therapies?

Complementary therapies are used alongside medical treatment, but alternative therapies are used instead of medical treatments. There’s no evidence that alternative therapies help treat cancer. Some alternative therapies have been studied and found to be ineffective or even harmful.1,2

References

References:

1. Cancer Australia. Complementary and alternative therapies. [Accessed 8/9/2024]. Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/complementary-and-alternative-therapies
2. Cancer Council Australia. Complementary therapies. [Accessed 8/9/2024]. Available at: https://cancer.org.au/cancer-information/treatment/complementary-therapies

Stage Selector

This site is tailored to meet you where you are, offering practical resources, personal stories, insights, and more—all in one easy-to-navigate space. By choosing the stage relevant to you, the information available on this site will be tailored to you.

Stage 1-3
Stage 4
All Stages

Glossary of Key Terms

These are explanations of terms that medical professionals and others may use when discussing your TNBC.

Advanced breast cancer

A commonly used term for secondary, metastatic or stage 4 breast cancer

Adjuvant therapy/treatment

Treatment (e.g. chemotherapy) given after surgery.

Alopecia

Hair loss

Areola

The area around the nipple

Axillary dissection/clearance

The removal of some or all of the lymph nodes from the armpit to see if the breast cancer has spread beyond the breast.

Benign

Not cancerous

Biopsy

The removal of cells or tissue from the body to see if they are cancer cells

BRCA1 and BRCA2

Women with a fault, or mutation, in one of these genes have a higher than normal chance of developing breast or ovarian cancer

Breast conserving surgery

Surgery to remove breast cancer and a small area of healthy tissue around the cancer. Also known as lumpectomy.

Chemotherapy

Treatment for cancer using drugs

Clinical trials

Studies involving patients to see if a new treatment is better than an existing one

Complementary medicines

Complementary medicines are products that are used in addition to conventional medical treatments (e.g. chemotherapy and hormone therapies). Complementary medicines include vitamin and mineral supplements, such as fish oil capsules or vitamin D tablets, and herbal medicines.

Complementary therapies

Complementary therapies are practices that are used in addition to conventional medical treatments (e.g. chemotherapy and hormone therapies).Some examples of complementary therapies often used by women with breast cancer include massage, yoga, acupuncture and reflexology.

Double mastectomy

Removal of both breasts during breast cancer surgery

Ductal Carcinoma In Situ (DCIS)

Non-invasive breast cancer confined to the ducts of the breast

Early breast cancer

Breast cancer that has not spread beyond the breast or lymph nodes under the arm

Early menopause

Menopause occurring in women under 45 years of age. Early menopause is often a side effect of some common treatments for breast cancer.

Lymph nodes

Glands in the armpit and other parts of the body that filter and drain lymph fluid, trapping bacteria, cancer cells and any other particles that could be harmful to the body

Lymphoedema

A condition that sometimes develops when lymph nodes have been removed during breast cancer surgery and the lymph fluid no longer drains freely, causing swelling in the arm, hand or breast

Lumpectomy

Another name for breast conserving surgery

Mastectomy

The removal of the whole breast during breast cancer surgery

Metastatic breast cancer

Another term for secondary, advanced, or stage 4 breast cancer

Multidisciplinary Team

Often abbreviated to MDT. A team of health professionals who work together to manage a patient’s treatment and care

Neoadjuvant chemotherapy

Chemotherapy treatment given before breast cancer surgery (sometimes used to reduce the size of the tumour to make it easier for the surgeon to operate)

Oestrogen

A type of female hormone

Partial mastectomy

Another term for breast conserving surgery

PBS (Pharmaceutical Benefits Scheme)

A scheme funded by the Australian Government to subsidise the cost of certain drugs for eligible consumers

Progesterone

A type of female hormone

Radiotherapy

Treatment for cancer using X-rays that target a particular area of the body

Secondary breast cancer

Breast cancer that has spread from the breast to other, more distant parts of the body, most commonly the bones, lungs, liver and sometimes the brain. Also known as advanced, metastatic, or stage 4 breast cancer.

Sentinel node biopsy

identification and removal of the first lymph node to which the breast cancer may have spread for testing by a pathologist

Seroma

Fluid that collects in or around a scar after surgery

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