Triple-negative breast cancer (TNBC) is a very rare type of breast cancer that don’t usually respond to the usual breast cancer treatment or therapies. But there are some other treatments that are available.

“Triple-negative” describes those cancer cells that usually test negative for the three types of receptors namely:

  • estrogen
  • progesterone
  • HER2

Due to its triple-negative status, TNBC doesn’t really respond to treatments that target the estrogen or the progesterone receptors. It also don’t usually respond to HER2 cancer treatment method such as trastuzumab (Herceptin).

But TNBC is sensitive to chemotherapy, which can shrink tumors so they’re easier to remove surgically.

About 12% of all breast cancer types are triple-negative. Most instances of TNBC are invasive ductal carcinoma, but ductal carcinoma in situ can also be triple-negative. The cell type, not the location, determines whether breast cancer is TNBC.

Black and Latinx people are more likely to develop TNBC than people of other ethnicities. A 2021 study found that Black women were 2.7 times more likely than white women to receive a TNBC diagnosis.

Many Black women don’t have access to the insurance or resources they need to manage this type of cancer. They may experience delays between diagnosis and treatment and challenges communicating with doctors.

People with mutations on their BRCA gene, especially on the BRCA1 gene, are also at risk for this type of breast cancer, as are those younger than age 50.

Types of treatment

Chemotherapy

A common TNBC treatment strategy is to begin with chemotherapy, either alone or in combination with the immunotherapy drug pembrolizumab (Keytruda). This helps shrink tumors so they’re easier to remove with surgery. It can also shrink affected lymph nodes.

Neoadjuvant chemotherapy (chemotherapy that occurs before other treatments) can eliminate invasive breast cancer about 30% to 50% of the time.

Research has found that when chemo can eliminate TNBC, the 5-year event-free survival rate is 92% and the 10-year event-free survival rate is 87%. Event-free survival includes cancer recurrence and further complications.

Your doctor might prescribe an oral chemotherapy medication called capecitabine (Xeloda) if there’s still cancer in the surgically removed tissue. You might also take more pembrolizumab. Women with the BRCA mutation might take an antitumor drug called olaparib (Lynparza) for 1 year to reduce the chance of cancer reoccurring.

Surgery

Sometimes an early-stage TNBC tumor is small enough for treatment to begin with surgery. The surgeon will remove the tumor and check your lymph nodes.

Surgery might involve either a lumpectomy, which removes the tumor while preserving breast tissue, or a mastectomy, which removes the entire breast and nearby lymph nodes.

If your lymph nodes contain cancer, your doctor may recommend radiation treatment. Chemotherapy after surgery is called adjuvant chemotherapy and is done to reduce the chance of a cancer recurrence.

Radiation

Radiation treatment uses high energy radiation that destroys remaining breast cancer cells. There are two typesof radiation treatment.

During external beam radiation, a machine outside your body will direct radiation to the target area.

For brachytherapy, or internal radiation, a healthcare professional will place radioactive material inside your body, next to the cancer site.

Immunotherapy

Immunotherapy works by boosting your immune system and teaching it to target cancer cells by controlling the action of protein checkpoints that turn your immune response on or off.

Pembrolizumab is an immunotherapy drug that targets an immune cell protein, PD-1. This protein usually stops immune cells from attacking. Pembrolizumab prevents PD-1 from blocking immune system cells so they can attack breast cancer cells. About 1 in 5 instances of TNBC have the PD-1 protein.

Clinical trials

Clinical trials are research studies using human volunteers. Trials are available for all stages of cancer.

If you’re part of a clinical trial, you might have advanced access to new treatments. By participating in a trial, you will also contribute to medical knowledge and progress in cancer treatments.

You can discuss the option of a clinical trial with your doctor. You can also find more information through the following online resources:

  • Search the TNBC Foundation clinical trial matching service.
  • Search for metastatic breast cancer trials.
  • Learn more about clinical trials.
  • Find National Cancer Institute (NCI)-supported clinical trials.
  • Learn about breast cancer trials.

Treatments by stage

TNBC treatment can vary, depending on how much your cancer has progressed. Your care team will provide you with specifics based on your situation.

Possible treatment options by stage might include:

Stage 1

  • lumpectomy, partial mastectomy, or mastectomy
  • lymph node biopsy or dissection
  • radiation
  • breast reconstruction
  • chemotherapy

Stage 2

  • neoadjuvant chemotherapy
  • lumpectomy, partial mastectomy, or mastectomy
  • lymph node biopsy or dissection
  • adjuvant chemotherapy
  • radiation
  • breast reconstruction
  • immunotherapy before and after surgery

Stage 3

  • neoadjuvant chemotherapy
  • mastectomy
  • lymph node dissection
  • adjuvant chemotherapy
  • radiation
  • target drug olaparib for cancer with BRCA mutation
  • immunotherapy drug pembrolizumab before and after surgery

Personalized treatment approach

Advancements to personalize treatment for TNBC are still in their infancy.

This is mainly because few effective treatments — other than chemotherapy — exist, and because there are few prognostic (related to a person’s overall outcome, regardless of therapy) and predictive (related specifically to treatment outcomes) biomarkers.

The BRCA mutation may present an opportunity for a precision treatment approach. It occurs in about 20% to 30% of TNBC cancer instances and responds to treatment using poly (ADP-ribose) polymerase (PARP) inhibitors.

Using pembrolizumab to target PD-1 is another personalized approach for TNBC cancer cells with this protein.

Research is ongoing to determine whether the aggressive nature of TNBC in Black women is because of health issues such as obesity or because of molecularly distinct characteristics. This may lead to much-needed precision treatment approaches for Black women.

Outlook

The NCI maintains a database called the Surveillance, Epidemiology, and End Results Program (SEER).

The SEER database tracks 5-year relative survival rates by grouping cancers into categories based on how far they’ve spread.

A relative survival rate is a comparison between a person with cancer and the overall population. For example, if you have breast cancer with a 90% 5-year relative survival rate, you’re 90% as likely to live for 5 years as a woman who doesn’t have cancer.

According to the American Cancer Society, the SEER 5-year relative survival rates for TNBC are:

  • localized (cancer is contained within the breast): 91%
  • regional (cancer is located in the breast and nearby lymph nodes and tissues): 65%
  • distant (cancer is located in distant areas like the liver, bones, or lungs): 12%
  • all stages combined: 77%

These percentages may be higher for women diagnosed now, since treatment methods improve over time.

The takeaway

Although TNBC is aggressive and doesn’t respond to the usual breast cancer therapies, it’s still treatable and may be curable in the early stages.

Black and Latinx women have higher rates of this type of cancer, and treatment may not be as effective for those populations.

Chemotherapy, surgery, radiation, and immunotherapy are some of the options that may be available for you to try.

Connecting with other people who share your experience, such as through a support group, can help.

Frequently Asked Questions

Triple-negative breast cancer (TNBC) doesn’t have estrogen or progesterone receptors and also makes too little or none of the HER2 protein. Because the cancer cells don’t have these proteins, hormone therapy and drugs that target HER2 are not helpful, so chemotherapy (chemo) is the main systemic treatment option.
After the 2020 approval of the combination of pembrolizumab and chemotherapy for advanced triple-negative breast cancer, FDA approved the combination therapy for people with early-stage disease in 2021.
Triple-negative breast cancer is usually more aggressive, harder to treat, and more likely to come back (recur) than cancers that are hormone receptor-positive or HER2-positive. The symptoms, staging, diagnosis, and survivorship care for triple-negative breast cancer are the same as other invasive ductal carcinomas.
Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. “Since these targets (hormone receptors and HER2) are absent in triple-negative breast cancer, chemotherapy is needed,” Sun says.
Route of first metastasis correlated significantly with survival of TNBC patients with brain metastases being the poorest survival indicator, followed by metastases to liver, pleura, bone, and lung.
Triple-negative breast cancer is “negative” for the two hormones and HER2 protein. Therefore, the targeted and hormone therapies used for other types of breast cancer are unlikely to be successful for triple-negative breast cancer patients.
A BRCA1 gene mutation is believed to make the body’s cells susceptible to further genetic alterations that can lead to certain types of cancer, including various forms of breast and ovarian cancer. Most breast cancers that are caused by a damaged BRCA1 gene are triple negative.
About 40% of people with stage 1 to 3 TNBC will experience a recurrence after treatment. However, many of those with TNBC will live long, disease-free lives. The overall 5-year relative survival rate across all stages of the disease is 77%.
Sixty percent of patients with triple-negative breast cancer will survive more than five years without disease, but four out of ten women will have a rapid recurrence of the disease.
Triple Negative Breast Cancer Treatment. This leaves chemotherapy and immunotherapy as the primary treatment options for triple negative breast cancer. For TNBC breast cancer that is in stage I through stage III, removing a tumor by surgery (before or after chemo) is sometimes an option if the tumor is small enough.
While many people with HER2-positive and triple-negative breast cancer do require chemotherapy, we can safely avoid chemotherapy in some people with hormone receptor-positive breast cancer.
Patients with triple-negative breast cancer are more likely to achieve pathologic complete remission, which is associated with improved survival. Despite this, patients with triple-negative breast cancer have an overall poorer prognosis compared to other subtypes, especially in the first few years after diagnosis.
While a TNBC diagnosis can be terribly scary, remember that it is not a death sentence. There are effective treatments for this cancer and many women go on to beat TNBC and live full lives, cancer-free. The earlier the cancer is caught, the easier it is to treat.
While treatable, metastatic breast cancer (MBC) cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent; median survival is three years. Annually, the disease takes 40,000 lives.
Ductal carcinoma in situ or DCIS. The cancer cells have not spread through the walls of the ducts into the nearby breast tissue. Nearly all women with DCIS can be cured.
Doctors consider triple-negative breast cancer more aggressive than other types of breast cancer. Therefore, they may recommend a mastectomy followed by radiation or chemotherapy. This treatment protocol can reduce an individual’s risk of recurrence and improve their survival rate.
When you multiply three negative numbers in math, you end up with a negative number, and the same is true for speech: Three negative words equal a negative meaning.
Triple negative breast cancer (TNBC) is a rare cancer that affects about 13 in 100,000 women each year. It represents about 15 % of all invasive breast cancers. Triple negative breast cancer is one of three types of breast cancer.
Route of first metastasis correlated significantly with survival of TNBC patients with brain metastases being the poorest survival indicator, followed by metastases to liver, pleura, bone, and lung.
For TNBC that remains local, the 5-year relative survival rate is 91%. For regional TNBC, it is 65%, and for distant TNBC, it is 12%. Combining the stages, the overall 5-year relative survival rate is 77%. It is possible for people with TNBC to live long lives even following a diagnosis.
In general, about 91% of all women with triple-negative breast cancer are still alive 5 years after diagnosis. If the cancer has spread to the lymph nodes near the breast (regional) the 5 year relative survival rate is about 65%. If the cancer has spread to distant places, the 5 year relative survival rate is 12%.