This is the fifth and final post in a series about FDA-approved treatments for each sub-type of MBC. Next week I’ll write about MBC in men, who represent about 1% of all patients.
The treatment description below for Triple Negative MBC patients has been reviewed with a Medical Oncologist at Columbia Presbyterian Hospital in NY. Detailed information about it is available in my book, "The Insider's Guide to Metastatic Breast Cancer" which is available as a paperback and eBook, and also a complimentary .pdf. For more information please visit: insidersguidembc.com/about
If the TNBC patient’s tumor has immune cells on or near it that are PD-L1 positive, then the patient should receive Atezolizumab (Tecentriq) in combination with Abraxane (nab-Paclitaxel). Atezolizumab is an FDA-approved immunotherapy drug that works well in combination with chemotherapy. If the cancer progresses, then other single-agent chemotherapy drugs may be considered, or a clinical trial may be an option. Combination chemotherapy should only be considered if there is visceral crisis (severe organ dysfunction and rapid progression of disease).
If the TNBC patient’s tumor-related immune cells are PD-L1 negative, then sequential single agent chemotherapy is recommended, and combination chemotherapy should only be given in the event of visceral crisis. A clinical trial may also be a viable option.
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Patients with bone metastases should receive a bone-directed therapy such as Xgeva (Denosumab) or Zometa (Zoledronic acid) in addition to their other therapy.
Patients with inherited (“germline”) BRCA mutations may want to speak with their medical teams about taking a PARP inhibitor such as Talazoparib (Talzenna) or Olaparib (Lynparza), which are FDA-approved for HER2 negative MBC patients with BRCA mutations.
If a US patient’s cancer has microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) characteristics (which are very rare), and if the patient has progressed on prior therapy and has no satisfactory treatment options, Keytruda (a PD-1 inhibitor also known as Pembrolizumab), is an FDA-approved option.
If a US patient’s cancer has a Neurotrophic Receptor Tyrosine Kinase (NTRK) gene fusion without a known acquired resistance mutation, and if there has been progression on prior therapy with no satisfactory treatment options, Larotrectinib (Vitrakvi) - an oral tyrosine kinase inhibitor that acts as an "on" or "off" switch in many cellular functions – is an FDA-approved option. NTRK fusions are extremely rare, occurring in only about 0.5–1% of common cancers.
Coming Home with Triple Negative Results
MBC lines of treatment- options
ER+ HER2- MBC treatments
Mbc and 2nd line treatment 
Does ER+ HER2- mutate to triple negative?
