Triple Negative Breast Cancer: New possibilities, new hope.

This article is my own view and based on my observations and conversations.

There has been a lot of focus on Triple Negative Breast Cancer (TNBC) over the last few years. As someone who's suffered a deep personal loss due to this terrible disease, I've always had an interest in following developments around it.

In my role over the last couple of years, I have had the opportunity to support Life Sciences organisations that are actively looking for newer treatments. I have also spoken with different research organisations and in particular the Institute of Cancer Research in the UK on this topic.

Cancer diagnosis is a life-altering experience. TNBC is resistant to traditional treatments, often leading to a poor prognosis for those diagnosed with it. But that’s changing fast, as a series of clinical breakthroughs and technology innovations are starting to transform the ability to treat – and ultimately prevent this disease.

The challenges of treating TNBC

Breast cancers are classified by receptors found on the cell surface. TNBC’s resistance to traditional cancer therapies is due to its lack of these hormone receptors, which are what cause most breast cancers to grow. When doctors diagnose breast cancer, they look for three types of receptors: estrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (HER2). If a lump diagnosed as breast cancer lacks all three, it’s classed as Triple Negative.

TNBC accounts for about 10-15% of all breast cancers. It spreads faster than other forms of cancer as standard treatments looking to block hormones or HER2 pathways are less effective. That has made it difficult to treat effectively, leading to lower five-year survival rates compared to other forms of breast cancer.

While surgery is often considered, the fact that TNBC spreads quickly means it’s often a race against time to remove a tumour and extend the life of the patient.

Emerging clinical treatments for TNBC

There have been significant developments to treat TNBC starting with more clinical trials than ever before looking at the disease in the neoadjuvant setting (before surgery), adjuvant setting (after surgery) and metastatic setting (when the cancer has spread).

Developments on the clinical side have led to new drugs, new collaborations, deeper insight into risk factors, and even the promise of a TNBC vaccine. There are more options today than only a few years ago.

New drugs: Research and development (R&D) efforts are resulting in promising new therapies for TNBC. The most recent success in this area has been with Trodelvy from Gilead which is an ADC or Antibody drug conjugdate approved for second line treatment of the disease. ADCs are essentially drugs linked to antibodies that target tumor cells. Similarly Datopotamab Deruxtecan (Dato-DXd) from AstraZeneca is now stage 3 of clinical trials. The success of ADCs offer new hope over traditional chemotherapy and these drugs could become first line (first choice) treatments for the disease.

Other approaches undergoing trials include a novel method from the National Cancer Centre in Singapore to convert highly aggressive cancer cells to become less aggressive with the use of an oral drug Bexarotene. This they believe enables chemotherapy to work better.

Traditional cancer drugs have however over the years struggled with poor solubility and permeability. They often struggle to penetrate tumor cells with the desired concentration. This issue is compensated by using a high dose of drugs and multi-drug regimens, which do have uninvited side effects. Yet another possibility in the future is to target both lymph nodes and the tumor with greater precision offered by the use of Nanotechnology. This overcomes the challenge of non-specific drug delivery. Research from the University of Michigan in the US could also lead on to better treatments in the future.

New collaborations: Life Sciences companies are putting patients first by partnering on this important objective. The recent partnership between Gilead and Merck, for example, will study the effectiveness of Trodelvy plus Keytruda in the Saci-IO trials to improve outcomes in certain circumstances. Keytruda when combined with chemotherapy has already improved treatment options and this new collaboration could advance it even further.

Potential vaccine: The ability to prevent TNBC through a vaccine is also being explored. Anixa Biosciences is currently conducting early stage trials of a vaccine aimed at those with higher risk of TNBC; a group that includes younger women, Black women and women with a BRCA1 mutation.

Technology has a growing role in the fight against TNBC

While Science is driving better outcomes, it is being enabled by a lot of work behind the scenes in Technology. Developments in data science, computational pathology and predictive modelling are happening globally. These are being used to study various elements such as what causes breast cancer, identification of those at high risk, modelling treatment options and monitoring the disease.

These are some of the themes I've seen -

Contribution of IT organisations: Bio-medical research consumes vast quantities of data. IT organisations within the Life Sciences industry are enabling innovative data platforms, niche technologies, lab information management systems and advances in Artificial Intelligence (AI) for their R&D users. Manufacturing processes are being transformed to Pharma 4.0 standards to ensure faster availability of drugs for patients globally. There are also efforts ongoing to keep Health Care Professionals (HCPs) informed about the latest clinical advances via intelligent marketing platforms. This is a huge part of discovering new drugs, bringing them to market and saving lives.

Contribution of Tech Majors: Cloud providers are starting to contribute too. Amazon has enabled faster image analysis via AWS Healthlake and are also enabling genetic research via AWS Omics while Microsoft is also supporting the industry with its AI for Health program which includes a current initiative to monitor cancer progression during treatment. Google too is using its cloud platform GCP in various initiatives including this one that uses AI to proactively identify women at a higher risk for breast cancer. While these are positive steps, there is still a long way to go and a lot more that can be done with the power of the cloud.

Contribution of research and government organisations: A great step forward in TNBC therapy would be to know how well a treatment is going to work before it is prescribed. Here in the UK, the Institute of Cancer Research (ICR) is exploring AI to model which combinations of drugs might be most effective for individual patients. Similarly the US National Institute of Health have demonstrated effective use of AI to more accurately predict treatment outcomes and guide care options.

NHS UK are also enabling Oncologists to make better decisions based on clinical trial data via computer models available on https://predict.nhs.uk

What does all of this mean?

There has been a lot of change over the last few years. For anyone who's recently diagnosed with TNBC, there is far more insight to the disease and even though oncologists may recommend standard first line treatments, there is continuous advancement of the choices available to them. There is also ongoing research to explore the role of genetics, diet and physical activity as risk factors for TNBC and to prevent recurrence.

All such advances are Science led and Technology enabled.

Thus when there is an entire industry motivated in solving the disease and so much collective focus, there is every reason to believe that things will only get better. ?