Unraveling Ethnic Disparities in Triple-Negative Breast Cancer (TNBC): Exploring The Impact of Metabolic, Reproductive, Environmental, and Social Factors on the Disease Course in African-American (AA) Women Population
Page: 1-21 (21)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010003
PDF Price: $15
Abstract
Triple-negative breast cancer (TNBC) is a particularly aggressive
subtype of breast cancer (BC) in which the expression of the estrogen receptor
(ER), progesterone receptor (PR) and human epidermal growth factor receptor
(HER2) is absent or very low. TNBC consists of approximately 15-30% of the
invasive BC cases in the United States (US) Women with TNBC represent a
heterogeneous population with regard to their ethnicity and biology including the
genetic make-up metabolic or hormonal profile as well as the socioeconomic status
(SES) cultural behavioral educational levels. Notably African-American (AA) women
usually have a higher prevalence of TNBC and a worse prognosis compared to
European-American (EA) or Non-Hispanic White (NHW) women. The goal of this
chapter is to elucidate the possible interplay of inherited and acquired, often lifestyle-related risk factors which can stimulate the initiation and development of the most
aggressive subtypes of TNBC in AA women compared to their EA (or NHW)
counterparts. In particular this chapter explores some ethnic disparities in TNBC
mainly in the example of the US where such disparities have been studied in clinical
research. This chapter also focuses on differences in TNBC risk factors healthcare
patterns clinical outcomes between AA and EA (or NHW) women. It briefly discusses
the multi-factorial etiology of these disparities e.g genetic, hormonal, metabolic,
behavioral, cultural, socio-economical and environmental. Presented short analysis of a
dynamic blend of inherited and acquired variables also provides some directions for the
reduction of these disparities, to improve TNBC outcomes, among women from ethnic
groups, such as AA.
A Closer Look at the Androgen Receptor (AR)- positive and AR-negative Metastatic Triple-Negative Breast Cancer: Can We Apply Novel Targeted Therapeutics?
Page: 22-38 (17)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010004
PDF Price: $15
Abstract
Based on the androgen receptor (AR) expression, triple-negative breast
cancer (TNBC) (that is estrogen receptor (ER), progesterone receptor (PR), and human
epidermal growth factor receptor 2 (HER2) negative), can further be divided into AR-negative TNBC (also known as quadruple-negative breast cancer (QNBC), a more
frequent TNBC subtype) and AR-positive TNBC.
The paucity of treatment targets makes QNBC very difficult to manage. Moreover, in
the absence of AR expression, many breast cancers (BCs) often display aggressive
behavior, leading to negative outcomes in afflicted women. At present, some novel
therapeutic targets have emerged, and hopefully, the relevant targeted strategies will
improve the survival of patients with QNBC.
This chapter briefly outlines the main TNBC subtypes and focuses on the AR
expression (its presence vs. absence), and potential treatment approaches, including AR
antagonists (ARA). In addition, this chapter overviews certain molecular
characteristics of TNBC and presents recently approved targeted therapies.
Liquid Biopsy: Insights Into Monitoring Tumor Dynamics and Response to Therapy in Patients with Breast Cancer
Page: 39-52 (14)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010005
PDF Price: $15
Abstract
The ability to identify the molecular features of metastatic breast cancer
(BC) provides a unique insight into a patient's therapeutic options and the opportunity
to follow the BC progress over time. A classical tissue biopsy remains the standard
procedure to describe tumor biology and guide treatment choices.
However, a liquid biopsy, which can provide medical practitioners with the
opportunity to detect genomic mutations and monitor therapeutic effects, can play a
prominent role in the diagnosis, therapy, and prognosis of patients with different
malignancies, including metastatic BC. In fact, the liquid-biopsy-based therapeutic
interventions led to the approval of alpelisib (a PI3K inhibitor) in patients with
hormone receptor (HR)-positive, human epidermal growth factor receptor2
(HER2)-negative, advanced or metastatic BC, in whom BC had progressed on or
after therapy with an aromatase inhibitor (AI).
This chapter describes a liquid biopsy in BC. It explores its potential for clinical
applications in early diagnosis, monitoring treatment response, detecting minimal
residual lesions, predicting risk of progression or recurrence, and estimating
prognosis. It compares a liquid biopsy with a tissue biopsy, and outlines the benefits
and limitations of each of these procedures, focusing on patients with metastatic BC.
Moreover, this chapter analyses the results from recent studies relevant to liquid
biopsies in BC (e.g., circulating tumor cells (CTCs) and circulating tumor DNA
(ctDNA)).
Importance of Biomarker Conversions as “Road Signs” to Manage Women with Metastatic Breast Cancer: How To Use Them for Personalized Care of These Patients?
Page: 53-64 (12)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010006
PDF Price: $15
Abstract
During a metastatic progression of breast cancer (BC), and upon
application of various antineoplastic therapies, the initial status of biomarkers can be
altered. Awareness of changes in hormone receptors (HR) and human epidermal
growth factor receptor 2 (HER2) is very important, because they may have an impact
on patient management. However, the procedures for monitoring these changes in
women with metastatic BC still remain unclear.
According to the guidelines for clinical practice from the American Society of
Clinical Oncology (ASCO), the reevaluation of metastatic BC lesions, is of great
importance, and it has been recommended that the biopsies of multiple metastatic
lesions need to be performed.
The aim of this chapter is to highlight the role of retesting receptor status in BC
metastases and the impact that this approach may have on the selection of therapeutic
strategies, in the individualized management plans for patients with metastatic BC.
In addition, this chapter concisely presents some novel biomarkers linked with targeted
therapies for metastatic BC.
Putting It All Together: Clinical Pearls of Recently Approved Therapies for Triple-Negative Breast Cancer
Page: 65-76 (12)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010007
PDF Price: $15
Abstract
Three recently approved therapies for the treatment of triple-negative
breast cancer (TNBC), including poly(ADP-ribose) polymerase (PARP) inhibitors,
immunotherapy, and antibody-drug conjugates (ADC) have changed the
management of several patients with advanced, metastatic, and even early-stage TNBC.
PARP inhibitors, such as olaparib and talazoparib, have been approved as therapies
for BRCA-mutated human epidermal growth factor receptor 2 (HER2)-negative
metastatic breast cancer (BC).
Immunotherapy has been approved for patients with programmed death ligand 1
(PD-L1)-positive, metastatic TNBC. Immune checkpoint inhibitors (ICIs), such as
atezolizumab and pembrolizumab demonstrated a significant improvement in
progression-free survival (PFS) (in combination with chemotherapy).
An antibody-drug conjugate (ADC), sacituzumab govitecan (SG) (that targets
trophoblast cell surface antigen 2 (Trop-2)), has shown efficacy and prolonged PFS
and overall survival (OS) in patients with metastatic TNBC.
The goal of this chapter is to briefly review some of the most promising therapies
available for the treatment of TNBC, including PARP inhibitors, ICIs, and ADCs.
Considerations of choosing these therapeutic options and their sequence, in the context
of the BRCA mutation and the PD-L1 positivity, in patients with TNBC have been
discussed.
The Way Out From the Labyrinth of Anticancer Therapies for Patients with Breast Cancer: How Can We Improve Their Cardiac Safety and Quality of Life?
Page: 77-95 (19)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010008
PDF Price: $15
Abstract
Patients with Breast cancer (BC) often experience a spectrum of adverse,
anticancer therapy-related symptoms, which deteriorate their quality of life (QoL).
Therefore, effective strategies for BC are needed. Personalized medicine offers many
therapeutic options (e.g., targeted therapies) that can be tailored to the individual needs
of a given patient.
This chapter aims to briefly present typical side effects of current anticancer
treatments, which often reduce the QoL of patients with BC and survivors. In
particular, it addresses pain (including chemotherapy (CHT)-induced peripheral
neuropathy (PN) and lymphedema), depression, cognitive dysfunction, premature
menopause, and CHT-induced menopause. It focuses on the adverse effects of the BC
therapies, such as chemotherapy (CHT), immunotherapy (IT), and some targeted
therapies. In addition, several issues related to cardiovascular toxicity induced by
anticancer treatments and cardioprotective measures for women with BC are
addressed. This chapter also touches on the recent advances in precision medicine and
provides some future directions, aimed at fulfilling unmet needs of patients with BC.
The described approaches may be helpful in planning personalized treatment,
facilitating the patient’s tolerability of many available anticancer therapies, optimizing
the medication selection, and improving the patient’s QoL.
Can We Find A Noninvasive Tool of Precision Medicine That Can Always Be Used For the Individualized Treatment of Women With Breast Cancer?
Page: 96-107 (12)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010009
PDF Price: $15
Abstract
A constellation of specific personal characteristics of the patients have been
described as personomics, which involves an individual patient’s personality type, set
of personal values, priorities, preferences, health-related beliefs, goals, economic
status, and different life circumstances, which can affect when and how a certain
disease (e.g., breast cancer (BC)) can be manifested in a given woman.
As a consequence, personomics can be considered to be a novel clinical instrument
that is helpful for making a connection between the standard and the emerging, more
individualized model of medical care. This plays an essential role in patients
diagnosed with the most aggressive and difficult-to-treat malignancies (e.g., BC
subtypes, such as triple-negative breast cancer (TNBC).
At present, many biological properties in the forms of different “omics” platforms
(such as genomics, proteomics, transcriptomics, metabolomics, epigenomics, and
pharmacogenomics) have emerged. They have been incorporated into precision
medicine. However, to optimally tailor diagnostic and therapeutic approaches to a
given patient, the biological characteristics need to be integrated with the personal
ones.
This chapter aims to address some practical research ideas of personalized medicine,
relevant to personomics that can incorporate individual patient issues into the
comprehensive therapeutic plan.
Distress – Our “Internal Enemy”: How to “Disarm” or Lessen its Negative Impact on the Psychophysical Condition of Women with Triple-Negative Breast Cancer?
Page: 108-117 (10)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010010
PDF Price: $15
Abstract
Stress is an inevitable part of life. It constantly bombards our lives, and
these explosions range from minor daily frustrations to overwhelming fear brought on
by the adverse prognosis of serious diseases, like triple-negative breast cancer (TNBC).
In patients with cancer, distress has been defined as “a multifactorial unpleasant
experience of a psychological (e.g., cognitive, behavioral, emotional), social, spiritual,
and physical nature that may interfere with the ability to cope effectively with
cancer, its physical symptoms, and its treatment. However, even in such a difficult
health-related situation, it is encouraging that some consequences of distress are not
inevitable. Some natural questions for every woman with cancer (e.g., TNBC) are:
“What are the normal limits of distress?” and “What to do when distress becomes
more serious?”
This chapter will briefly address the above questions and will present some tools that
can be used to measure distress. In addition, a few simple strategies that are easily
accessible and effective in Distress Management and its complications will be
suggested (e.g., “Do's and Don'ts” list of recommendations).
Teaching the Brain How to Counteract Distress: Practical Lessons About the Stress and Relaxation Responses for Women with Triple-Negative Breast Cancer
Page: 118-128 (11)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010011
PDF Price: $15
Abstract
In spite of a very difficult situation, women with triple-negative breast
cancer (TNBC) need to realize that some consequences of the cancer-related distress
can be alleviated. Moreover, it is possible to counteract, to some degree, the damaging
effects of this distress. In particular, the relaxation response, as the opposite,
“calming version“ of the “typical” stress response can be achieved by a given patient
with cancer, with some simple, intentional, and conscious efforts.
In fact, modern stress management offers a whole armamentarium of tools and
strategies that are necessary to reduce negative results of stress-related reactions. Since
many warning signs of stress are connected with certain activities of the autonomic
nervous system (ANS), it should be beneficial to patients to learn some basic
information about the ANS functions.
This chapter will explain how to elicit the relaxation response as the “common
denominator” to counterbalance the “typical” stress response. It will also teach how to
use diaphragmatic breathing, and the most feasible to adopt elements of the
mindfulness-based interventions, as well as cognitive-behavioral approaches, to
more effectively combat distress daily.
An Intersectional Neuroscience Approach for Disadvantageous Populations: Meditation Practice as a Possible Support Option for Women with Breast Cancer?
Page: 129-138 (10)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010012
PDF Price: $15
Abstract
Mindfulness and compassion meditation have a positive impact on
cognition, mood, behavior, and general health, based on recent studies in neuroscience.
However, the research methodology is still insufficient to determine and measure
different mental states during meditation, especially in minority populations.
Intersectional Neuroscience, which is an innovative research model, may provide
some solutions since it adapts modern research procedures to include disadvantageous
groups of participants (e.g., ethnic minorities, patients with chronic diseases, like
cancer, heart disease, or depression). Evaluating Multivariate Maps of BODY
Awareness (EMBODY) is a task designed to accommodate diverse neural structures
and functions, using the multi-voxel pattern analysis (MVPA) classifiers, with
functional magnetic resonance imaging (fMRI). The EMBODY task applies
individualized artificial intelligence algorithms to the fMRI data, in order to identify
mental states during breath-focused meditation, a basic skill that stabilizes
attention.
This chapter describes a potential application of the Intersectional Neuroscience (IN)
approach to developing useful metrics of meditation practice, including participants
from disadvantageous groups. Hopefully, these findings can be explored in-depth, and
possibly applied to patients with triple-negative breast cancer (TNBC), in the future.
May We Adjust the “Third Wave” of Cognitive and Behavioral Therapies (CBT) and Psychological Processes of Change for Women with Breast Cancer?
Page: 139-153 (15)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010013
PDF Price: $15
Abstract
To emphasize on the suffering of women with breast cancer (BC), it is
necessary to identify and deeply understand many aspects of BC etiology,
development, and complex management. However, the strategies for achieving these
goals for individual patients often need to be refocused, or redirected, based on
personal expectations, needs, and circumstances that can differ considerably among
women with very aggressive BC, such as triple-negative breast cancer (TNBC). The
main goal of cognitive-behavioral interventions is to change some specific thoughts,
emotions, and behaviors and teach constructive coping skills and behavioral
modifications, which will aid in building an individual activity plan, coordinated with
cancer-related therapies.
This chapter will present the concept of the “third-wave” cognitive and behavioral
therapies (CBT) and the importance of psychological processes of change, in
supportive care interventions, for patients with TNBC. Adding such processes of
change should facilitate the development of personalized care solutions for better
outcomes for many patients suffering from BC, despite their poor prognosis. This
should encourage the patients, caregivers, and their medical care teams to learn, and
then, apply these safe interventions in their individualized contexts.
Exceptional Responders: Exploring the Molecular “Make-up” of Patients with Cancer Who Experienced Recovery
Page: 154-165 (12)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010014
PDF Price: $15
Abstract
Patients with cancer, who have achieved an unexpectedly favorable and
long-term clinical response are commonly known as exceptional responders (ER).
Such patients have often experienced extraordinary responses to some oncology
therapies, which have been ineffective for other individuals with similar malignancies.
These unusually positive responses may be partially due to some unique genetic and
molecular mechanisms, which can be further studied. This, in turn, could provide some
directions to a better understanding of why the specific therapy works for only a small
number of patients with cancer, but not for everybody. To further elucidate these
issues, the National Cancer Institute (NCI) has been conducting various research
projects to explain biological processes, which can be responsible for these remarkable
responses.
A recent pilot study, known as the Exceptional Responders Initiative (ERI), has
evaluated the feasibility of identifying exceptional responders retrospectively, by
obtaining pre-exceptional response treatment tumor tissues and analyzing them with
modern molecular tools. The promising findings of this study can inspire many women
with breast cancer (BC) and their medical teams.
This chapter presents a synopsis of the ERI. It suggests some possibilities to adjust this
concept for patients with breast cancer (BC) (e.g., advanced or metastatic triplenegative breast cancer (TNBC)).
Radical Remissions: Unique Lessons from Patients with Cancer Who Were Able to Defy the Odds and Recover
Page: 166-180 (15)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010015
PDF Price: $15
Abstract
Many women with aggressive BC subtypes are devastated, due to metastatic
spread, resistance to therapy, and poor prognosis. However, there is a growing body of
scientific evidence that some patients have been able to defy the odds of advanced
malignancy and recover, in spite of their fatal prognosis and dismal oncology statistics.
Also, these “better than expected” clinical effects were not totally rare.
To explore this fascinating subject, future research is undoubtedly necessary. In line
with this challenge, the innovative “Radical Remission Project” was created, which
allows collecting cases of Radical Remissions for research studies. It also connects
survivors with patients, who actually struggle with aggressive cancers. Since there is a
concern about giving false hope to patients with advanced malignancies, they need to
be professionally informed that the cases of Radical Remissions must be first explored
in detailed research studies, before making any conclusions about their potential
applicability to patients with similar prognoses. This is necessary to protect the most
vulnerable patients, who must not be given any false expectations, and the practical
communication skills of the cancer care teams are crucial to accomplish it.
In addition, Complementary and Integrative Medicine (CIM), which manages the
physical, mental, emotional, and spiritual needs of patients with cancer, regardless of
their prognosis, appears to be helpful in an attempt to meet these needs. CIM is
gradually becoming a part of each stage of the cancer journey, from active to
supportive and palliative oncology care. Similarly, integrative oncology that uses
evidence-based, lifestyle modifications, mind-body techniques, and specific natural
products in combination with conventional anticancer treatments is in line with
patients’ safety.
This chapter briefly addresses some universal factors, which can make a genuine
difference to help in recovery from cancer, based on the Radical Remission Project
and CIM-related research. It focuses on the role of open and precise communication
between patients and cancer care teams. The ongoing Radical Remission Project can
inspire many women with breast cancer (BC) and their medical teams to consider
introducing some safe and useful approaches to their standard oncology management.
How Can We Redefine Hope and Gratitude to Help Patients with Breast Cancer Build Their “New Life”?
Page: 181-190 (10)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010016
PDF Price: $15
Abstract
There is a need to practically redefine the future way of life, among
numerous patients with breast cancer (BC). In fact, spirituality, hope, and gratitude
may play a remarkable role in a possible transformation into a “new life”. Also, these
invisible, positive “forces” recognize patients as individual human beings, which
should be connected with their families, caregivers, friends, and medical professionals,
as functional “units”.
This chapter provides some suggestions for practical approaches to help design a
functional “new life”, especially for women with aggressive BC (e.g., triple-negative
breast cancer (TNBC)). In addition, medical care teams may consider incorporating
such supportive modalities into the main therapeutic oncology plan.
The Self-kindness Component of Mindfulness Meditation: A Helpful Strategy to Enhance Emotion Regulation and Reduce the Depression and Distress Symptoms in Women with Breast Cancer
Page: 191-197 (7)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010017
PDF Price: $15
Abstract
It has been demonstrated that one of the components of mindfulness
meditation, called self-kindness, plays a prominent role in alleviating distress
perception, and reducing depressive symptoms, especially among younger women
with breast cancer (BC), who represent a particularly vulnerable patient population,
often struggling not only with a serious illness but also with numerous family and
work-related obligations.
This chapter will describe in detail self-kindness as a technique to help ease distress,
anxiety, and depressive feelings, as well as enhance resilience and establish objective
health-related expectations or goals for patients with cancer, including women with
an aggressive subtype of BC, such as triple-negative breast cancer (TNBC).
Compassion-Focused Therapy (CFT): Introducing a Process-based System of Psychotherapy to Help Patients with Breast Cancer
Page: 198-205 (8)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010018
PDF Price: $15
Abstract
Compassion-focused therapy (CFT) integrates techniques from cognitivebehavioral therapy with concepts from psychology and neuroscience. The main
objective of CFT is to use compassionate mind training to help individuals develop and
maintain the experiences of inner warmth and stability, through the cultivation of
compassion (including self-compassion).
This chapter will describe in detail self-compassion as a technique to help ease
distress, anxiety, or depressive feelings, as well as enhance resilience and establish
objective health-related expectations and goals for patients with serious chronic
diseases, such as cancer, including triple-negative breast cancer (TNBC).
How Can Medical Professionals Maintain Compassion for Their Patients with Breast Cancer?
Page: 206-217 (12)
Author: Katarzyna Rygiel*
DOI: 10.2174/9789815196023123010019
PDF Price: $15
Abstract
Compassion in the medical field differs from its traditional meaning in daily
life. In medicine, compassion includes a desire to understand an individual’s
suffering, together with a wish to relieve it. In essence, compassion offers a unique
concept, according to which, the modern science of compassion can be practically
applied to suffering people, in many circumstances. This is particularly important for
some vulnerable groups of patients (e.g., ethnic minorities), such as women with
breast cancer (BC) (e.g., in advanced or metastatic stages, with comorbidities and
socioeconomic problems).
This chapter presents some suggestions (based on recent research reports) for helpful
strategies that medical professionals can use daily, to help maintain compassion
for their patients with serious diseases, including some aggressive cancers (e.g.,
Triple-Negative Breast Cancer (TNBC)).
Introduction
This comprehensive reference is a timely exploration of two vital aspects of triple-negative breast cancer. The book offers a holistic perspective that helps readers to navigate the challenges of managing triple-negative breast cancer (TNBC) with knowledge and confidence. Understanding Ethnic Disparities and Targeted Therapies: This section provides a critical overview of the ethnic disparities and the latest targeted therapies available for patients facing advanced or metastatic triple-negative breast cancer (TNBC). Empowering Patients and Enhancing Communication: This section dives into the essential role of patient education, empowerment, effective communication with medical teams, and psychological or supportive approaches, providing invaluable insights into managing advanced or metastatic breast cancer (BC). Key Features: Introduces a groundbreaking perspective on the TNBC journey, encouraging patients to view their battle with the disease as an opportunity to leverage modern pharmacological advancements and psychological support for improved outcomes. Bridges the gap between clinical or research-related aspects of BC management and the personal needs and expectations of patients, promoting a more holistic approach. Invites perspectives from a wide range of medical professionals, from oncologists and cardiologists to psychologists and nurses, to engage in open dialogues with patients, offering practical education and crucial support. Provides a wealth of helpful resources (including an appendix) for both patients and their medical caregivers, fostering a comprehensive and supportive approach to managing TNBC. This book is an informative resource for medical professionals, researchers, and patients, who want to understand the complexities of triple-negative breast cancer and apply current knowledge in their clinical and caregiving practice.