Genetic Testing and Sequencing Essential in Metastatic Triple-Negative Breast Cancer, Expert Urges
Key Insights
Germline genetic testing should be performed for all patients with metastatic or early-stage triple-negative breast cancer (search), according to Dana-Farber Cancer Institute oncologist Ilana Schlam, MD, MPH.
Tumor sequencing in the metastatic setting can identify targetable mutations that may open additional lines of therapy for patients.
Black patients tend to develop triple-negative breast cancer (search) at earlier ages, and genetics has so far not been able to explain these racial disparities.
Genetic testing and tumor sequencing represent critical tools in the management of triple-negative breast cancer (search) (TNBC), with experts emphasizing that these approaches should be standard practice for both early-stage and metastatic patients to identify potentially actionable mutations.
Ilana Schlam, MD, MPH, a breast medical oncologist at Dana-Farber Cancer Institute, underscored the importance of comprehensive genetic assessment in a recent interview. "I think something very important is to make sure we have germline genetic testing done for all patients with metastatic or early triple-negative breast cancer (search)," Schlam said.
For patients with metastatic TNBC, Schlam highlighted that sequencing takes on additional significance given the expanding clinical trial landscape and the potential to uncover targetable alterations. "Considering sequencing, it's also important as we have, especially here, we have a lot of trials, and we could consider additional lines of therapy if they have targetable mutations," she noted.
The rationale behind this approach centers on the therapeutic implications of identifying actionable genomic alterations. When targetable mutations are found, patients may gain access to additional treatment options that would otherwise remain unexplored, potentially altering the disease trajectory in a subtype of breast cancer known for its limited therapeutic avenues.
Racial Disparities in TNBC Incidence and Onset
Beyond the clinical imperative for genetic testing, Schlam also addressed the persistent and poorly understood racial disparities observed in triple-negative breast cancer (search). Black patients, she noted, tend to develop TNBC at earlier ages compared to other populations, a pattern that has prompted extensive investigation.
"There are some differences in terms of incidence and age of onset in African American patients. We know that Black patients tend to have triple-negative breast cancer (search) often at earlier ages," Schlam stated. "There's been a lot of research done to try to understand why."
Despite considerable scientific effort, the underlying mechanisms driving these disparities remain elusive. "Genetics has so far not been able to explain that, and assessing environmental factors can be challenging, but that's a possibility," Schlam explained, acknowledging the complexity of disentangling potential contributors.
The gaps in current understanding underscore the need for continued investigation. "There's still a lot of work going on to try to understand why there are differences between race and ethnicity across triple-negative breast cancer (search) patients," Schlam concluded, signaling that this remains an active and pressing area of research within the breast oncology community.