Understanding Triple-Negative Breast Cancer - Episode 3
Kristie L. Kahl: Can you explain how diet and nutrition plays a role in a triple-negative breast cancer diagnosis and maybe even through treatment?
Dr. Ogori Kalu: So diet and nutrition is something that's very important for women who are diagnosed with breast cancer, in particular triple-negative breast cancer, as far as contributing to their diagnosis. I think, in general, we have attributed certain diets that could contribute to increasing a woman's risk of developing breast cancer – diets that are high in salt, diets that are high in sugar, diets that are high in animal fats, and also diets including high alcohol intake and also tobacco use. So that would mean women who have obesity issues, uncontrolled diabetes, uncontrolled high blood pressure, which can all be, in essence, related to diet and lifestyle (would) have an increased risk of not only developing cancer, but having a poor prognosis once they are diagnosed with cancer.
Kristie L. Kahl: Similarly, how does diet and nutrition play a role when it comes to survivorship?
Dr. Ogori Kalu: So similarly, exactly. We try to tell women we have to control your blood pressure, control your blood sugars, that's a given. We always encourage women to increase their vegetable/fruit intake, as well as lean protein intake, to have a more active lifestyle. This is not, of course, the cure all end all, but these are things we know contribute to longevity, as far as improved quality of life and a longer life. If you have a well-balanced diet, if you're physically fit, trying to eliminate tobacco and alcohol or any extraneous sort of toxins in the body.
Kristie L. Kahl: Are there specific types of food that patient should avoid?
Dr. Ogori Kalu: I may get a lot of flack for this, but I am someone who's wholeheartedly for a vegetable-based diet. I wouldn't say totally cut out all meat, because it's difficult. But we do know that red meat, especially higher intakes of red meat, does have contributions towards the development of cancers, as well as quality of life and mortality implications for those who are already diagnosed. We do know that added sugars or things with high sugar contents also contribute to higher mortality rates. So I would say stay away from anything with added sugar, stay away from high fatty foods. Try, if you're a meat eater, more lean meats. Staying away from red meats, increasing more fish, vegetables, fruits – more of a balanced diet with a high vitamin and mineral content, I think, would be ideal for someone if they want to improve their lifestyle and their mortality.
Kristie L. Kahl: Are there any misperceptions or wives’ tales that we can address when it comes to diet and nutrition and a cancer diagnosis?
Dr. Ogori Kalu: Some people feel that just having, for example, an alkaline diet will eliminate cancer or eliminate the need for treatment once you're diagnosed and will sort of be a cure-all for your cancer. Once it's diagnosed, there's no one diet or one element that will completely cure cancer, at least none that I know of at this point. But we do know that all these things can contribute to a better outcome. So I just want to encourage patients, don't abandon traditional medications or traditional treatment options to take on a wholehearted sort of holistic or organic diet and lifestyle. (Patients) should go hand-in-hand for treatment of cancer. So I think that's the biggest myth that I like to bust: If you just have a whole heart and natural lifestyle, you can abandon traditional medicine or treatment options for cancer.
Kristie L. Kahl: Would you recommend that a patient consider seeing a nutritionist to help them through treatment and into survivorship?
Dr. Ogori Kalu: Once a woman is diagnosed with cancer, particularly triple-negative breast cancer, because all of these patients will need chemotherapy, that is the standard-of-care recommendation for the treatment, irrespective of what stage you're diagnosed at. Once you start with these chemotherapeutic medications, it alters the way you feel from the side effects of the medication. So it's very important that you maintain a healthy diet through this medication to maintain your strength, as well as just for a better quality of life. So we always recommend once a person is diagnosed, immediately see a dietitian. And of course, there are some patients who already come in with pre-existing medical conditions. So a dietitian, of course, would be key to help them going through the process of treatment and even after treatment and what kind of diet they should maintain to have a healthier outlook.
Treatment Options for Triple-Negative Breast Cancer
Kristie L. Kahl: How does stage affect the type of treatment a patient will receive for triple-negative breast cancer?
Dr. Ogori Kalu: For triple-negative breast cancer, irrespective of the stage at diagnosis, one thing is for sure is that the woman is going to receive chemotherapy or that chemotherapy will be recommended for that patient. But then, outside of chemotherapy, the stage (of the disease) would determine what kind of surgery they would have, plus or minus radiation. So, of course, the lower or the earlier the stage – stage 1 and maybe stage 2 – the patient could have breast-conserving therapy where they just take out the tumor, and then (the patient) would need radiation, versus some women who may be recommended to have their entire breasts removed, which is a mastectomy, plus or minus reconstruction. And then radiation might be an option as well. So for sure, they would need chemotherapy. They're different options for surgery, depending on what stage they're diagnosed. And then radiation is added, depending again, on what kind of surgery they have and whether or not they have more advanced disease.
Kristie L. Kahl: You just went over some options for early-stage triple-negative breast cancer. What are the current standards of care for advanced disease?
Dr. Ogori Kalu: So for this disease, the standard of care is typically to start a woman off with chemotherapy upfront with advanced disease, which I would include from stage 2 onwards. Usually, chemotherapy is recommended upfront. Chemotherapy allows the clinician to have an idea of how well the tumor responds to the chemotherapeutic treatment, give a better idea of their overall prognosis, given what is made available to them at the time for treatment, and also will help determine what further treatment, meaning surgery or radiation, would be needed after the initial chemotherapy.
Kristie L. Kahl: Are there different standards of care for recurrent disease?
Dr. Ogori Kalu: So, there's no difference in the standard of care, I believe if there's just a difference in the kind of way the cancer presents itself in the patient. So once a woman has had breast cancer, initially a triple-negative disease and has been treated, once it comes back or presents itself in a metastatic setting, then there's a host of different options. A medical oncologist knows how to treat that patient, and that all depends on how the patient responded initially from her initial medical treatment, and what kind of tumor also that she has, which would correspond to which medications that the oncologist will think is appropriate this second go round, to effectively treat the patient.
Kristie L. Kahl: With so many different treatment options, why is the multidisciplinary approach in triple-negative breast cancer treatment so important?
Dr. Ogori Kalu: Well, the multidisciplinary approach typically includes the medical oncologist, the radiation oncologist, an internist, the dietician, social worker, possibly a plastic reconstructive surgeon, a patient navigator/care coordinator. So the importance of all of these people in the woman's treatment plan is that everyone is on the same page of what the patient needs at the time and how to coordinate (their care) in a timely fashion so that there's no gaps in treatment. Multidisciplinary approaches are also beneficial because you have different perspectives on the best way to treat this patient's cancer. You know, not everyone is the same. We can't have cookie cutter treatment plans for everyone, because different things are going on in a woman's life that could actually either interfere with what you think is best or need to take into consideration for the different treatment plans that you're recommending. So, it's very important to have different perspectives to get the best treatment option for the patient because she would know what's best and what would work best for her.
Kristie L. Kahl: What are some of the exciting treatments that are in the pipeline?
Dr. Ogori Kalu: The most exciting treatments out there for triple-negative breast cancer are what we call immunotherapies, which are more targeted therapies towards triple-negative disease. This is all part of what's going on in the pipeline and going through clinical trials right now, but they seem to all have a common denominator, which is what we call immunotherapy targets that would be specific for these cancer cells. And I think that's the most exciting thing that we are looking forward to seeing come into mainstream for treatment.
Kristie L. Kahl: What do you think patients with triple-negative breast cancer have to look forward to when it comes to the treatment landscape?
Dr. Ogori Kalu: Well, I think they have more options made available to them, which are also less toxic options, because we know what we're giving now, for some women, it's very hard to tolerate. So I think that's something to look forward to in the future, something more specific, more targeted, that will actually treat the cancer more effectively, and also things that are less aggressive and less toxic. So I'm very hopeful that we will see these treatment options become readily available within the near future.