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I Was Diagnosed With Triple Negative Breast Cancer At 36 — The Signs To Look Out For

As a physician assistant with over a decade of experience on the frontlines of healthcare, I considered myself knowledgeable about breast cancer. I knew that breast cancer is typically diagnosed in middle-aged and older women. I knew that between ages 40 and 45, it's recommended that women start getting annual mammograms. I was more informed than the average person, yet the Stage 3C triple-negative breast cancer (TNBC) diagnosis I received at 36 years old hit me like a punch in the face.

I've learned a lot since then, about the signs to look out for, the importance of self-advocacy, and the need for tailored resources and support for people living with advanced and metastatic breast cancer (MBC).

There's a significant gap between what most women know about breast cancer and what they need to know to be their own best advocate.

TNBC is different from other types of breast cancer. It's more commonly diagnosed in women younger than 40 compared to other subtypes and twice as common in Black women compared to white women. It's considered an "aggressive" cancer because it tends to grow and spread faster than other subtypes.

Through my physician assistant education, I was taught that mammograms aren't needed until age 40. But with an aggressive form of cancer like TNBC, where Black women are dying at a much higher rate than any other group of women, we need to be screened earlier. Had I waited to have a mammogram, I might not have made it to my 40th birthday. I am proof that early detection can save lives.

Don't be afraid to push for the care you deserve. Seek second opinions, ask questions, and educate yourself about your condition.

When I was diagnosed, I had just stopped breastfeeding my youngest daughter when I felt a lump in my left breast. At the time, I didn't think much of it because I knew that weaning can cause lumpy breasts and most lumps are not cancerous. A few weeks later I still felt the lump, so I scheduled a virtual appointment. My doctor ordered a mammogram, and breast ultrasound and ultimately, conducted a biopsy.

The need for self-advocacy — especially among Black women — first became apparent when I had to insist on receiving the diagnostic tests that my doctor had ordered because they looked at my age and said, "You don't need a mammogram. You're too young for this. You just need an ultrasound." But, I knew what my doctor had ordered and was able to push to get the diagnostics I needed.

Then, during the mid-portion of my adjuvant chemotherapy, I found out about a new immunotherapy for TNBC. When I asked my oncologist why I wasn't receiving it, I didn't get a good answer. He never welcomed a discussion about the treatment or my interest in participating in a clinical trial.

After that, I made a complaint, spoke to his chief, and got another oncologist. Eventually, I was able to gain access to the treatment through participation in a clinical trial, and, along with my post-adjuvant chemo, I responded well. Because of my persistence, I'm able to sit here today and encourage other women to advocate for their own treatment needs as if their lives depend on it — because in many cases, it does. Your health is worth fighting for.

Because TNBC can be more aggressive, early detection is vital. Familiarizing yourself with the signs of breast cancer can empower you to take charge of your health.

The key is to be aware of potential signs like a new lump or thickening in the breast or armpit, changes in breast size or shape, or nipple discharge. TNBC is also more common in women with a BRCA1 gene mutation, which you can be tested for, especially if you have a strong family history of breast cancer.

I've learned that it's also important to know yourself. While incredibly important to help with early detection, mammograms do not find every breast cancer. Or if you're like me — you might be younger than the typical screening age. This means it's also important for you to know what your breasts normally look and feel like, so you'll be able to detect any changes.

Support groups and resources tailored to the specific needs of women living with advanced or metastatic breast cancer can make a big difference.

After taking the time I needed to process and accept my diagnosis, I started posting videos about my experience in hopes of connecting with other women, especially those who look like me, are my age, or are moms, too. That experience inspired me to start my non-profit organization, The Tatas 365, which is focused on screening high-risk Black women for breast cancer at earlier ages.

Storytelling can be a powerful educational tool. Advanced or metastatic breast cancer — no matter the subtype — is different from an early-stage diagnosis and can feel especially isolating and scary. Learning from others who have similar experiences and day-to-day challenges living with this disease makes us stronger in the face of it.

ASCO 2024: MSD's ADC Shows Efficacy In Lung And Breast Tumours

Merck & Co (MSD) has announced positive data for its antibody-drug conjugate (ADC) therapy, sacituzumab tirumotecan from two studies that recruited patients with lung and breast cancer.

The company released first-time data from the open-label Phase II trial (NCT05351788) in patients with advanced non-small cell lung cancer (NSCLC) along with additional data from the Phase III study (NCT05347134) with the ADC in patients with advanced or metastatic triple-negative breast cancer.

The results will be presented at the upcoming American Society of Clinical Oncology (ASCO) Annual Meeting taking place in Chicago from 31 May to 4 June.

Sacituzumab tirumotecan is a trophoblast cell-surface antigen 2 (TROP2)-targeting antibody linked to a belotecan-derivative topoisomerase I inhibitor payload. It has the same antibody as the Gilead Sciences' breast cancer ADC therapy Trodelvy (sacituzumab govitecan), but has a different payload and linker. MSD licenced the ADC therapy along with six other ADC candidates from China-based Sichuan Kelun-Biotech (Kelun) in 2022.

The Phase II trial evaluated sacituzumab tirumotecan in combination with Kelun's programmed cell death-ligand 1 (PD-L1) targeting monoclonal antibody, KL-A167, in treatment naïve NSCLC patients. The patients were non-randomised to receive 5 mg/kg of sacituzumab tirumotecan every three weeks (Q3W) in addition to either 1,200 mg of KL-A167 Q3W (cohort 1A) or 900 mg of KL-A167 once every two weeks (cohort 1B).

As of 2 Jan 2024, the 40 participants in cohort 1A, who had a longer median follow up of 14 months, demonstrated an objective response rate (ORR) of 48.6% and median progression-free survival (PFS) of 15.4 months. The 63 patients in cohort 1B who only had a median follow up of only 6.9 months, did not reach median PFS but had a six-month PFS rate of 84.6% and an ORR of 77.6%.

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One patient in the 1B cohort discontinued the study due to drug hypersensitivity. Commonly observed Grade 3 or 4 treatment-related adverse events (TRAEs) included decreased blood counts such as neutropenia, leukopenia, and anaemia along with rash and drug eruption.

The Phase III study compared sacituzumab tirumotecan to chemotherapy in 263 patients with locally recurrent or metastatic triple-negative breast cancer. The study met the primary endpoint of PFS by demonstrating a 69% reduction in risk of progression or death, based on an interim analysis with a data cutoff of 21 June 2023.

Based on the blinded independent central reviews (BICRs), the therapy has a median PFS of 5.7 months, compared to a median PFS of 2.3 months with chemotherapy. Sacituzumab tirumotecan had an ORR of 43.8% compared to a 12.8% ORR with chemotherapy.

As of 30 November 2023 data cut off and a median follow-up of 10.4 months, median OS was not reached in the sacituzumab tirumotecan therapy group, compared to a median OS of 9.4 months with chemotherapy. The common TRAEs included decreased blood counts similar to the Phase II NSCLC trial.

Both Phase II and III studies were funded by Kelun. MSD is evaluating sacituzumab tirumotecan in combination with the company's PD1 therapy Keytruda (pembrolizumab) as a first-line treatment in patients with metastatic NSCLC in a Phase III trial (NCT06170788). The trial is expected to enrol approximately 614 participants and will conclude in 2028.

Multiple companies are expected to present data for their ADC therapies at ASCO. ADCs have been an area of interest in recent months, with MSD announcing investments to boost its ADC portfolio. In October 2023, the company partnered with Daiichi Sankyo to develop and commercialise three of the latter's DXd ADC candidates, potentially spending up to $22bn on the partnership.

Gilead's Trodelvy Woes Rise With Failed Bladder Cancer Trial

Gilead Sciences' TROP2-directed drug Trodelvy has missed the target in another clinical trial, this time in urothelial carcinoma, the most common form of bladder cancer.

The results of the TROPiCS-04 study compared Trodelvy (sacituzumab govitecan) to chemotherapy as second-line treatment for patients with locally advanced or metastatic UC previously treated with chemo and immunotherapy with PD-1/PD-L1 inhibitors.

The top-line result is that Gilead's antibody-drug conjugate (ADC) performed no better than chemo at extending patients' lives – a worrying result for Gilead, as TROPiCS-04 was the confirmatory study designed to upgrade Trodelvy's accelerated approval in previously-treated UC, which was granted by the FDA in 2021.

There were also more deaths due to adverse events with the drug compared to chemo, mainly resulting from neutropenia, and the company said it is "working to reiterate to treating physicians the importance of […] G-CSF use for the prevention of neutropenic complications."

It added that it is "continuing to analyse the data and will discuss the results and next steps with the FDA."

The disappointing result also comes just a few months after Trodelvy was unable to increase overall survival compared to chemo in the EVOKE-01 study in previously treated non-small cell lung cancer (NSCLC).

Gilead has said it is exploring a trend towards improvement in a subgroup of patients who did not respond to prior immunotherapy, and new data from EVOKE-1 is due to be presented at the ASCO congress later today.

Later at the meeting, it will also present the results of the phase 2 EVOKE-02 study of Trodelvy in combination with MSD's Keytruda (pembrolizumab) in first-line PD-L1-high NSCLC.

The two failures have come as Gilead is facing competition in the TROP2 ADC category from AstraZeneca and Daiichi Sankyo's datopotamab deruxtecan (Dato-DXd) – recently filed for HR-positive, HER2-negative breast cancer and in non-squamous NSCLC – as well as MSD/Kelun's sacituzumab tirumotecan, which has pivotal data in breast cancer ready to disclose at ASCO.

Along with its UC indication, Trodelvy is also FDA-approved for previously treated metastatic triple-negative breast cancer (TNBC) – where it has suffered from comparison with data on AZ and Daiichi Sankyo's HER2 ADC Enhertu (trastuzumab deruxtecan) – and hormone receptor-positive/HER2-negative metastatic breast cancer.

At the moment, Gilead is the only company going after UC, but - with competitors catching up and threatening to overtake it in other indications - Trodelvy is starting to look vulnerable.

Sales of the ADC were $1.1 billion last year and reached $309 million in the first quarter, and it is a key component of Gilead's plans to make one-third of revenues from cancer drugs in 2030. That target has also been affected by problems besetting its CD47-targeting antibody magrolimab and Arcus-partnered A2 receptor antagonist etrumadenant.

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