Breast cancer is not one type of disease but many. The type of breast cancer affects prognosis and care options. TNBC is an aggressive type of breast cancer and Dr. Erika Hamilton (from Sarah Cannon) will clarify misconceptions about TNBC and address key questions, like who is at greatest risk for TNBC and what are current care options.
About Dr. Hamilton
Erika Hamilton, MD
Director, Breast Cancer and Gynecologic Cancer Research Program, Sarah Cannon Research Institute; Principal Investigator, Sarah Cannon Research Institute at Tennessee Oncology
Dr. Hamilton joined Sarah Cannon in 2013. Dr. Hamilton cares for patients with breast and gynecologic cancer. As the director of the breast cancer and gynecologic cancer research program, she oversees the program and the clinical trial menu for these cancers across the Sarah Cannon network. After receiving an undergraduate degree from Washington and Lee University in Virginia, Dr. Hamilton completed her medical degree and residency from the University of North Carolina in Chapel Hill. She received her fellowship training in hematology and oncology from Duke University in Durham, North Carolina, where she was recognized as a Top 5 Finalist for Duke’s Annual House staff Fellow Teaching Award. She is board certified in internal medicine and oncology. Additionally, she is a partner with Tennessee Oncology, PLLC.
Support for Real Pink comes from Genentech, a member of the Roche group who pursues groundbreaking science to discover and develop medicines for people with breast cancer. Learn more at gene.com. From Susan G Komen. This is real pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
Breast cancer is not just one disease. There are many types of breast cancers, triple-negative breast cancer is an aggressive subtype of breast cancer that is not frequently talked about here today to clarify important misconceptions about TNBC and to address key questions surrounding risks and current care options is dr. Erika Hamilton director of the breast cancer and gynecologic cancer research program at the Sarah Cannon Research Institute. Dr. Hamilton, welcome to the show.
Dr. Hamilton (01:06):
Thanks so much for having me happy to be here.
Well, I really appreciate you joining us. Is there anything else that you’d like to tell us about yourself before we dive into some questions here?
Dr. Hamilton (01:14):
No, I think you’ve got it right. So I lead our breast cancer research program here at Sarah Cannon. So I see patients in clinic a couple days a week, and the rest of my time is spent managing our research portfolio and trying to advance therapies for cancer patients.
Well, that’s fantastic. I really appreciate the work that you’re doing. So let’s dive in. As we know, breast cancer is a group of disease types, including triple negative breast cancer or TMBC. So what is TMBC and how is it different from other types of breast cancer?
Dr. Hamilton (01:45):
Yeah, you’re absolutely right. Triple negative breast cancer is a more rare, some type of breast cancer. What triple negative means is there’s three markers. We look at for breast cancers to classify them the estrogen receptor or ER, the progesterone receptor or PR, and then this other protein called her too. And so most cancers that we see that are breast cancers are hormonally driven or they express the estrogen and progesterone receptors triple negative is named triple negative because it’s negative for all three of those. And so that really comprises about 10 to 20% of breast cancer.
Okay. Gotcha. And what makes it more difficult to treat than the other types of breast cancer? And it, I, it is more difficult to treat, is that correct?
Dr. Hamilton (02:28):
It is. It tends to be more aggressive and faster-growing. And so what’s kind of unique about triple-negative breast cancer is that traditionally in the past, we haven’t had any targeted medicines to treat it. For example, we have estrogen blockers like Tamoxifen and aromatase inhibitors for hormonally driven breast cancers. And we have antibodies against her too for breast cancers that are her two positive, but in the past triple negative breast cancer has really only had chemotherapy. We haven’t had any specific part in the triple negative cancer that we can target to treat it. So the other thing that’s a little bit complicated about triple negative breast cancer is that triple negative breast cancer really isn’t just one disease. There are different driving mutations in genes and profiles within the triple negative breast cancers that make it not quite a uniform entity. And so that can be a little bit tricky because one patient with triple negative breast cancer may respond to something and someone else may not.
Okay. Okay. That, yeah, that does seem really complex. And so related to some research on that, I know that you were an investigator on the impassion 130 clinical trials, which studied a new treatment option for patients with metastatic TMBC. Can you tell us a little bit about the results of the impassion one 30 trial and what treatment options are available for patients with TMBC?
Dr. Hamilton (03:46):
Absolutely. So a little over a year ago, Atezolizumab was approved for the metastatic or incurable first line, triple-negative breast cancer. And specifically, it was approved for a subset of those patients with first-line triple-negative disease whose cancers express an immune marker called PD-L1. And that ends up being about 40% of triple-negative cancers. And on this trial, women were given a common chemotherapy backbone called NAB paclitaxel, and they either got it by itself with placebo or in combination with the [inaudible] and by adding a teaser Elysium add to that NAB paclitaxel, we improved the survival and those women from about 15 months up to 25 months. So almost a year improvement.
Hm that’s fantastic.
Dr. Hamilton (04:33):
We now have some data from clinical trials in the early-stage setting that immunotherapy may be helpful there as well, although there are no approvals there currently.
Well, and, and you know, that was that trial. Are there any other, like, are there other treatment options available as well for TNBC.
Dr. Hamilton (04:50):
Certainly, we have a host of chemotherapies for those patients. There’s also a newer recently approved drug. And that was approved several months ago and that’s for more heavily predict pretreated, triple-negative cancer. So people that have already had two regimens in the metastatic setting, so that particular drug has an antibody-drug conjugate. So it’s been quite an exciting past year or so for triple-negative before we just had chemotherapy. And now we have an immunotherapy drug and a new antibody-drug conjugate.
Wow. That’s fantastic. That’s great news. And so how like walk me through how common is TMBC and who is at the highest risk for developing it?
Dr. Hamilton (05:34):
Yeah, so, so I said that you know, triple-negative breast cancer is about 10 to 20% of all breast cancers, but the statistic that I think, you know, a lot of people don’t recognize is that one in eight women will get breast cancer at some point in their life. So because breast cancer is so common, even a subtype of that, that’s only about 10 to 20% still makes it where there’s a lot of people that are diagnosed triple-negative cancer each year, right. And anyone can get triple-negative breast cancer, but it does tend to be more common in younger women. So when somebody’s younger comes in, they tend to have, you know, more likely to have those aggressive type cancers. It also tends to be more common in African American women or Hispanic women. And then there’s also some genes that give you a genetic predisposition to breast cancer VRC one or two. And those really got a lot of notoriety around Angelina Jolie, having that in the surgery choices she made, et cetera, but 70% of breast cancers in people with the BRC gene mutation are triple-negative.
Hmm. Okay. And my last question here, what are some of the common misconceptions around TMBC that you hear from patients?
Dr. Hamilton (06:45):
Gosh, I think there are so many misconceptions about cancer in general, but with triple-negative, I think people tend to hear that it’s aggressive, which is completely true, but I think there’s a misconception that some people, you know, are terrified when they’re diagnosed with triple-negative and they think that it’s just not curable. Triple-negative is still curable. If it’s caught early, it’s not necessarily destined to spread. Certainly, some people do end up with recurrent or metastatic disease at presentation, but that’s not the case for everyone. And then I think one of the other misconceptions that really frustrates me is that there’s a misconception that patients did something wrong to get it, that they didn’t eat something they should have, or they ate too much of something else or they dye their hair. They don’t exercise enough. And I hear a lot of comments from this kind of patient blaming culture, where women are made to feel that somehow they’re responsible for developing their cancer. And I think this comes from a human tendency to try to distance yourself from the possibility of something bad happening. So if you hear that somebody might’ve gotten cancer, you kind of think, Oh, well, that’s not going to happen to me because X, Y, or Z, right. That’s really kind of a dangerous thought process because by doing that, you’re kind of blaming somebody else for getting cancer. That really wasn’t their fault.
Hmm. I’m really glad that you shared that because that, that is a really dangerous way of thinking. And I really would like for our listeners to understand that that’s not right, right. That’s not the way we should be thinking about it. It, it, it comes and it happens and it’s unfortunate. We can’t blame the people that are suffering through it. So dr. Hamilton, this has been fantastic. Is there any, are there any final thoughts that you’d like to share with us?
Dr. Hamilton (08:20):
Yeah. I guess one final thought I’d like to add and, and I’m guilty of this. And I think we’re all guilty of it a little bit is that sometimes I say she, but another misconception is, is that men certainly can get breast cancer too. And so it is true that the vast majority of people that are diagnosed with breast cancer tend to be women, but it’s not a cancer of just women. Men get breast cancer as well. And we are certainly trying to involve them more in clinical trials and they have some unique things about their cancers that are sometimes different. So I just want to raise awareness about that as well.
Well, that I really appreciate that. And Dr. Hamilton, this has been fantastic. I really appreciate you coming on the show and maybe I can have you back again sometime.
Dr. Hamilton (8:57): Thank you so much for having me. I enjoyed it.
Thanks for listening to real pink, a weekly podcast by Susan G Komen for more episodes, visit RealPink.komen.org for more breast cancer visit komen.org. Make sure to check out at Susan G Komen on social media. I’m your host, Adam, you can find me on Twitter at @ajwalker or on my blog. AdamJwalker.com. Thanks to Genentech for supporting real pink, to find out more about Genentech’s latest advancements. Visit gene.com.
About this Episode
Intro and outro music is City Sunshine by Kevin MacLeod. Ad music is Blue Skies by Silent Partner.