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Understanding Triple Negative Metastatic Breast Cancer: An Interview With Jennifer Diamond, MD

Triple-negative metastatic breast cancer may have a well-deserving reputation for being notoriously difficult to treat, but fear not!

How triple-negative breast cancer works

Exciting things are on the horizon for those of us living with this disease, as illustrated by my interview with the incredible Colorado-based Dr. Jennifer Diamond. She explains how the disease works, its treatments, as well as new areas of research.

Q: What is your role with the University of Colorado at Anschutz Medical Campus?
A: I am currently the Co-Director of the Women's Cancer Developmental Therapeutics Program (WCDT) and Phase I, Expansion, and Molecular Studies Program (POEMs) at the University of Colorado Cancer Center. I am a medical oncologist and a physician-scientist. I am an Associate Professor of Medicine in the Division of Medical Oncology.

Q: What makes triple-negative metastatic disease unique?
A: Triple-negative breast cancer is a term for breast cancers that lack expression of the hormone receptors (estrogen and progesterone receptors) and do not over-express HER2. These cancers are different in that they lack these targets, but there is great heterogeneity within triple-negative breast cancer itself. There is a lot of interesting research ongoing to try to divide TNBC into subgroups that may allow us to develop individualized, targeted therapies.

Q: You run the Diamond laboratory, "focused on the development of novel targeted therapies for triple-negative breast cancer." Can you please talk about what you are currently working on in the lab?
A: In our laboratory, we are working on the development of new combinations of treatment that may overcome resistance to chemotherapy and trying to understand why cancers develop resistance to chemotherapy. We are particularly interested in how p53 mutations may impact response to treatment and how targeted drugs may work with immunotherapy drugs in TNBC.

Immunotherapy for triple-negative

Q: What treatment(s) are you most excited about at present or coming out in the future for triple-negative metastatic disease?
A: One of the most exciting treatments in TNBC right now is immunotherapy. This type of treatment allows your own immune system to help in fighting the cancer. We think that immunotherapy works best for patients with TNBC when it is given in combination with chemotherapy. Based on the IMPASSION130 trial, atezolizumab is approved for the treatment of patients with PD-L1-positive metastatic TNBC, and the KEYNOTE 355 trial was recently presented at ASCO reporting benefit for pembrolizumab added to chemotherapy in PD-L1-positive patients. Pembrolizumab is not yet FDA-approved for this indication, but this data is certainly promising. Sacituzumab govitecan was recently FDA-approved for patients with metastatic TNBC that has been previously with chemotherapy. This treatment is an antibody-drug conjugate that delivers high concentrations of chemotherapy directly to tumor cells and surrounding tissues. Many other types of targeted treatments are also being tested including PI3K inhibitors.

Q: Do you recommend any lifestyle choices for people living with triple-negative metastatic breast cancer?
A: It is important for patients living with metastatic TNBC to eat a healthy diet and get as much exercise as they can depending on the type of treatment that they are receiving, side effects of treatment and symptoms of their cancer. Simple things like taking a walk each day can help to manage fatigue-related to treatment. Many patients find that meditation or acupuncture can help them to manage side effects, as well. A cancer diagnosis is frightening, but stage IV is especially so.

Advice for newly diagnosed

Q: Do you have advice for those newly-diagnosed?
A: It’s important to lean on people in your life that can provide you with support to help you through. Oncology clinics are generally staffed by experienced doctors, nurses, pharmacists, social workers, and in some cases dieticians and psychologists to help you navigate treatment. I encourage patients to remember that everyone's journey is unique and people respond to treatment differently. We are fortunate to have many treatments available that can work for metastatic TNBC to keep cancer under control and alleviate symptoms.

To conclude, triple-negative metastatic breast cancer has a lot of promising treatments, and more to come. To learn more about triple-negative breast cancer, please visit The Triple Negative Breast Cancer Foundation.

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