TNBC ppt

Santhiram College of Pharmacy, Nandyal COPY RIGHTS RESERVED
Case Presentation On
TRIPLE NEGATIVE BREAST
CANCER
Presented by:
D.Prasad
Reg.No:18HC1T0007
Pharm. D Intern
SEPTEMBER-2019 EDUCATION FOR PEACE & PROGRESS Pharmacist Case Presentation /S2
• Defination :Breast cancer is a disease in which cells

in the breast grow out of control. There are
different kinds of breast cancer. The kind of breast
cancer depends on which cells in the breast turn
into cancer.
• The most common kinds of breast cancer are
• Invasive ductal carcinoma
• Invasive lobular carcinoma
Invasive ductal carcinoma.:

The cancer cells begin in the ducts and then grow
outside the ducts into other parts of the breast tissue.
Invasive cancer cells can also spread, or metastasize,
to other parts of the body.
Invasive lobular carcinoma. :
Cancer cells begin in the lobules and then spread
from the lobules to the breast tissues that are close
by. These invasive cancer cells can also spread to
other parts of the body.
• Breast cancer is the most common cancer in

women worldwide. It is a highly heterogeneous
neoplasm with distinct subtypes. These subtypes
are commonly grouped into four categories based
on the immunohistochemical expression of
hormone receptors: estrogen receptor positive
(ER+), progesterone receptor positive (PR+), human
epidermal growth factor receptor positive (HER2+)
• Accordingly, the following four subtypes of breast

cancer are widely recognized:
• Group 1 (luminal A). This group includes tumors
that are ER positive and PR positive, but negative
for HER2. Luminal A breast cancers are likely to
benefit from hormone therapy and may also
benefit from chemotherapy.
• Group 2 (luminal B). This type includes tumors that
are ER positive, PR negative and HER2 positive.
• Luminal B breast cancers are likely to benefit from

chemotherapy and may benefit from hormone
therapy and treatment targeted to HER2.
• Group 3 (HER2 positive). This type includes tumors
that are ER negative and PR negative, but HER2
positive. HER2 breast cancers are likely to benefit
from chemotherapy and treatment targeted to
HER2.
• Group 4 (basal-like). This type, which is also called
triple-negative breast cancer
• includes tumors that are ER negative, PR negative

and HER2 negative.
• Triple-negative Breast Cancer : (TNBC) is a subtype

of breast cancer that based on
immunohistochemistry (IHC) is estrogens receptor
(ER) negative, progesterone receptor (PR) negative
and human epidermal growth factor receptor 2
(HER2) negative.
• TNBC is characterized by a distinct molecular
profile, aggressive nature and lack of targeted
therapies.
• A histological study of basal-like tumours, all being
ER/PR/HER2 negative.
• Symptoms
• Changes in breast shape.
• Mass or suspicious finding on a mammogram.
• Breast or nipple pain.
• Discharge from the nipple.
• Swelling of the breast.
• A lump.
• Thickening of the nipple skin.
• Diagnostic tests:
• 3D mammograms (tomosynthesis)
• Breast ultrasounds
• Breast MRIs
• Breast biopsy and interventional breast procedures
• PET/CT scan
• IHC
• FISH TEST
• INVESTIGATIONS:
• Complete HEAMOGRAM
• LFT
• RFT
• Blood Culture & Sensitivity test
• Urine Culture & Sensitivity test
• Serology: HIV / HCV
• Mammogram:
• A mammogram is an X-ray of the breast that helps
detect breast cancer early. It can find lumps that
are too small to be felt during a clinical breast
exam.
• TNBC lacks the typical suspicious mammographic
features of breast cancer; namely irregular mass
shape, spiculated margins and associated
suspicious calcifications. Therefore,
mammography alone is usually a sub-optimal tool
for its initial diagnostic evaluation.
• Significance of Mammogram:
• To find abnormal % Mass , %Focal assymetry
density or architectural distortion
• masses were evaluated for size, shape and margin.
• Margins of a mass were reviewed for being
circumscribed, obscured, microlobulated, indistinct
and spiculated.
• Breast Ultrasound: Ultrasound is a safe,

noninvasive imaging test that does not use
radiation or x-ray exposure. During a breast
ultrasound, gel is placed on the surface of the
breast and an external probe is moved to transmit
and collect sound waves.
• Ultrasound is the mainstay of evaluation for the
regional nodal basins, including the ipsilateral
axillary, infraclavicular, internal mammary and the
supraclavicular nodes.
• Demonstrating the extent of nodal disease
• Breast biopsy: Biopsy is a procedure during which a

small piece of your breast tissue is removed and
examined for the presence of malignant cancer
cells.
• Excisional biopsy: We remove the whole abnormal
area and some surrounding tissue, similar to a
lumpectomy.
• Incisional biopsy: We remove only part of the
tumor. This type of biopsy is not as common as an
excisional biopsy.
• Breast MRI: Magnetic resonance imaging (MRI)

uses radio waves and strong magnets to provide
more information than a mammogram or
ultrasound. It helps us identify breast cancer and
determine a tumor's location, size and stage.
Significance of MRI :
• descriptions of presence of tumor (mass, non-
mass, mass with non-mass component,
• focus), margins (well defined/ill defined), shape
(regular/
• irregular), multifocality, internal enhancement
characteristics (homogeneous, heterogeneous, rim
enhancement)
• PET/CT SCAN: Positron emission tomography, also

called PET imaging or a PET scan, is a type of
nuclear medicine imaging.
• Nuclear medicine uses small amounts of
radioactive material called radiotracers.
• To diagnose, evaluate, and treat various diseases.
These include cancer, heart disease,
gastrointestinal, endocrine, or neurological
disorders.
• common uses of the procedure:

• detect cancer and/or make a diagnosis.
• determine whether a cancer has spread in the
body.
• assess the effectiveness of treatment.
• determine if a cancer has returned after
treatment.
• evaluate prognosis.
• assess tissue metabolism and viability.
• determine the effects of a heart attack

myocardial infarction on areas of the heart.
• identify areas of the heart muscle that would
benefit from angioplasty or coronary artery
bypass surgery (in combination with a myocardial
perfusion scan).
• evaluate brain abnormalities, such as tumors,
memory disorders, seizures and other central
nervous system disorders.
• Significance of PET/CT SCAN:

• PET/CT may be helpful in identifying unsuspected
regional nodal disease and/or distant metastasis in
locally advanced breast cancer . PET/CT also has
high sensitivity and specificity in diagnosing distant
metastatic foci.
• Although locoregional recurrence and distant
metastasis after the initial treatment carry a
poorer prognosis, early detection of the
recurrence can improve survival
• Diagnosis
• Axillary Lymph Node Staging
• Distant Metastasis Staging
• Treatment Response Evaluation
• Recurrence
• Radiotherapy Planning
• IHC :
• exploits the relationship between an antibody
and an antigen to visualize protein expression
in situ.
• IHC combines immuno-detection with
advanced microscopy in a way that is relatively
streamlined and straightforward, yet
extremely versatile.
• IHC is used in clinical settings to identify

various pathogenic features—such as
neoplasia, metastasis, infection, and
inflammation—within tissue samples for
diagnostic purposes.
• IHC is dependent upon antibody detection of
specific proteins of interest in a tissue sample.
• Steps in IHC :
• IHC stain results:

• 0 or 1+, HER2-negative, indicates a cancer that may
not respond to medicines targeting that protein.
• 2+, Uncertain, means FISH testing may be needed
to get a better reading.
• 3+, HER2-positive, signals a cancer that will likely be
treated with HER2 drugs.
• FISH test:
• Fluorescence in situ hybridization (FISH) is a
test that “maps” the genetic material in a
person’s cells. This test can be used to
visualize specific genes or portions of genes.
FISH testing is done on breast cancer tissue
removed during biopsy to see if the cells have
extra copies of the HER2 gene.
• The more copies of the HER2 gene that are
present, the more HER2 receptors the cells
have.
• Abnormalities found in cancer cells include:

• Translocation. Part of one chromosome has broken
off and relocated itself onto another chromosome.
• Inversion. Part of a chromosome is in reverse
order, although it is still attached to the correct
chromosome.
• Deletion. Part of a chromosome is missing.
• Duplication. Part of a chromosome has been
copied and the cell contains too many copies.
• FISH uses fluorescent DNA probes to target specific

chromosomal locations within the nucleus,
resulting in colored signals that can be detected
using a fluorescent microscope.
• FISH broadened to include more genetic diseases,
hematologic malignancies, and solid tumors
• FISH detection of BCR/ABL1 translocation, HER2
amplification, and ALK rearrangement is critical for
guiding targeted therapy in chronic myeloid
leukemia , breast cancer , and lung
adenocarcinoma, respectively.
Patient demographic details

• KABHK : 0000203728 • Patient name : NITASA
• Department : Medical • Age- 34 years

oncology • Gender- FeMale
• Ward : T1 3F • Weight : 51.5 kgs
• Date of admission: • Height : 165 cms
• Date of collection: • BSA:1.55 m²
20/02/2024
Subjective evidence
Chief complaints:
K/c/o Metastasis of carcinoma of Breast Progressive disease
(brain and liver ) on chemotherapy.
Admitted for D1 of 2 nd cycle of SACITUZUMAB GOVITECAN ,
With complaints of generalized weakness,
Appetite normal
Bladder and Bladder habits regular.
Past medical History:

Patient was Presented with lump in the left breast for 3
months, with loss of weight and Backpain
USG Breast shows Hypoechoic left breast mass ,lower
quadrant 2×2 cm with axillary lymphnode.
Biopsy shows invasive ductal carcinoma grade 2
IHC reported HR positive , PR 2 positive and HER2 negative ,
Ki67 -8 to 10% , BRCA 1 negative.
2nd line chemotherapy with inj PACLITAXEL ang INJ CARBOPLATIN

3 Rd line chemotherapy with AC Regimen
4 th line chemistry with INJ FULVESTRANT On 28/03/2023 along with INJ
Zoledrenic acid and INJ ZOBONE 3monthly last cycle on 29/05/23.
She completed 1st cycle of 5 th line chemotherapy with INJ ERIBULIN D1 and
D8 On 17/06/23 Planned for 3 more cycles.On 6/6/23.
H/o Radiation therapy with Cyberknife to dose of 30GY In 5 fractions to
metastatic brain Lesion on 13/06/23 to 17/06/23.
Patient received 6 th cycle of 5 th line chemotherapy with INJ ERIBULIN
Admitted for supportive care with c/o backpain radiating to leg, MRI Spine
shows altered marrow signals , received radiation therapy 40y in 10
fractions to Metastatic vertebral lesion on 19/12/23 to 30/12/2023.
Patient received D8 of 1cycle chemotherapy with SACITUZUMAB GOVITECAN
on 30 /01/2024 to 8/01/2024 With c/o loose stools .
• Co morbidities : Nill
• Physical examinations :
• Thoracic spine tenderness ++
• General condition: moderately built and nourished
• Vital signs : stable
• No cyanosis, clubbing , Lymphnodes and pedal edema
• CVS : S 1 and S2 heared
• RS : cleared
• PA : Soft ,Bowel ++
INVESTIGATIONS:
Blood counts
• Biochemistry:
• Blood cultures and Sensitivity ( aerobic) :

• No growth after 7 days incubation
• Culture and Sensitivity Urine manual:

• No significant bacteria growth In culture
• Course in the hospital:
• Discharge medication:
• Follow up
Diagnostic tests
DAY-1 Plan RX
DAY 2 RX
RX
DAY-3
RX
Day-4
Treatment Chart
Treatment Chart
Critical evaluation
Patient Counseling
LIFE STYLE MODIFICATIONS
References

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Santhiram College of Pharmacy, Nandyal COPY RIGHTS RESERVED

• Defination :Breast cancer is a disease in which cells

Invasive ductal carcinoma.:

• Breast cancer is the most common cancer in

• Accordingly, the following four subtypes of breast

• Luminal B breast cancers are likely to benefit from

• includes tumors that are ER negative, PR negative

• Triple-negative Breast Cancer : (TNBC) is a subtype

• Breast Ultrasound: Ultrasound is a safe,

• Breast biopsy: Biopsy is a procedure during which a

• Breast MRI: Magnetic resonance imaging (MRI)

• PET/CT SCAN: Positron emission tomography, also

• common uses of the procedure:

• determine the effects of a heart attack

• Significance of PET/CT SCAN:

• IHC is used in clinical settings to identify

• IHC stain results:

• Abnormalities found in cancer cells include:

• FISH uses fluorescent DNA probes to target specific

Patient demographic details

• Department : Medical • Age- 34 years

Past medical History:

2nd line chemotherapy with inj PACLITAXEL ang INJ CARBOPLATIN

• Blood cultures and Sensitivity ( aerobic) :

• Culture and Sensitivity Urine manual:

• Course in the hospital:

LIFE STYLE MODIFICATIONS

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