Triple Negative Breast Cancer: Expert Consensus on Local Treatment Options

Hong Kong Breast Cancer Foundation Launches "Immunotherapy Drug Financial Assistance Programme" to Benefit Patients in Need

HONG KONG, Nov. 30, 2023 /PRNewswire/ -- Breast cancer is the leading cancer facing women in Hong Kong. According to the statistics released by the Hong Kong Cancer Registry of the Hospital Authority in October 2023, breast cancer accounted for 28.5% of female cancer cases, ranking first. In 2021, there was a total of 6,400 newly diagnosed breast cancer cases in women in Hong Kong, comprising 5,565 invasive breast cancer and 835 in situ (or non-invasive) breast cancer, representing a 13% increase from the previous year. Since 2011, the incidence of invasive breast cancer in women has increased by 62.8%, which is significantly higher than the overall increase of 50.4% for female cancers.^[1]

Triple Negative Breast Cancer (TNBC) is a subtype of breast cancer with higher invasiveness. It is known for its faster progression, higher tendency to metastasize to other organs, and relatively higher rate of recurrence. According to the 2021 Hong Kong Cancer Registry statistics, out of all newly diagnosed cases of invasive breast cancer in females, there was a total of 517 patients with TNBC^[1], which represents 9.29% of all newly diagnosed cases of invasive breast cancer. The Hong Kong Breast Cancer Foundation (HKBCF), in collaboration with over 60 local experienced medical professionals (including surgeons, clinical oncologists, and medical oncologists), formed a multidisciplinary expert panel. This panel developed a local consensus on the treatment of early-stage TNBC based on the latest medical evidence, international treatment guidelines, and the local healthcare system, providing guidance for the medical community in Hong Kong. To ensure that patients with early-stage high-risk TNBC receive appropriate treatment, the Foundation has launched the "Immunotherapy Drug Financial Assistance Programme." This programme offers financial support to eligible patients, with the first phase benefiting approximately 100 patients and involving a funding exceeding HKD 20 million.

Dr. YAU Chun-chung, a member of the expert panel and Vice Chairman of Management Committee of HKBCF, explained that TNBC refers to cases where estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) test results are negative. Due to the absence of these hormone receptors, hormone therapy and targeted therapy have limited effectiveness in treating TNBC. Radical surgery has been the primary treatment for TNBC patients, but recently, pre-operative neoadjuvant chemotherapy has been introduced to shrink tumors before surgery, increasing the opportunity for breast-conserving surgery, thus avoiding the need for total mastectomy. ^[2] If a patient achieves "pathological complete response", meaning complete disappearance of the tumor after neoadjuvant treatment, and no cancer cells are found in the postoperative pathological examination, the prognosis is relatively better. ^[3]

After extensive discussions and voting, the expert panel reached a local treatment consensus. Regarding diagnosis, the panel agreed that immunohistochemistry (IHC) testing should be performed on every breast cancer patient to determine the ER, PR, and HER2 status for appropriate classification and personalised treatment planning. In terms of treatment, neoadjuvant therapy should be considered as the standard and preferred treatment option for stages II and III TNBC patients, provided that the patient's clinical condition is suitable. Furthermore, doctors should also consider combining immunotherapy with chemotherapy as part of neoadjuvant and continue immunotherapy as adjuvant treatment for TNBC patients.

Dr. YAU pointed out that the combination of immunotherapy and chemotherapy as neoadjuvant and adjuvant treatment for stages II and III early-stage TNBC patients can enhance treatment effectiveness. According to international medical data, this approach can increase the chance of achieving "pathological complete response" to 65% and significantly prolong event-free survival compared to chemotherapy alone. ^[4] "Patients may potentially avoid total mastectomy by receiving immunotherapy followed by chemotherapy as pre-operative neoadjuvant treatment, which could shrink the tumor. This could greatly improve the patients' psychological well-being and quality of life," he added.

Dr. Eliza FOK, Chairman of HKBCF, said, "Following the medical advancements in recent years, with the diagnosis and analysis by the expert panel, a new dawn is brought to patients with early-stage high-risk TNBC. The combination of immunotherapy drugs and chemotherapy as neoadjuvant and adjuvant treatment provides not only appropriate treatment but also alleviates physical discomfort for patients."

To support this group of early-stage high-risk TNBC patients, HKBCF has launched the "Immunotherapy Drug Financial Assistance Programme", which offers financial assistance for eligible patients to access treatment. Each approved patient will receive a cash subsidy of HKD 13,600 per treatment cycle. Eligible participants are required to meet the following criteria:

1. holder of valid Hong Kong Identity Card; and
2. diagnosed as early-stage high-risk TNBC; and
3. referred by an accredited treating physician from public hospitals, private hospitals or clinics*; and
4. under the treatment of immunotherapy drug Pembrolizumab of 200 mg or 400 mg per cycle.

*patients referred by private sector shall pass financial assessment (personal income of recent 12-month average is less than HKD 60,000 per month).

Dr. Eliza FOK added, "We understand the cost of cancer treatment is exorbitant, making it difficult for many families to afford immunotherapy treatments which can cost tens of thousands of dollars per session. This burden is even greater for lower-income citizens.  HKBCF is committed to walking alongside patients and lessening the financial burden they face in accessing expensive immunotherapy treatment. The programme is divided into the 'Public Hospital Drug Financial Assistance Programme' and the 'Private Hospital/Clinic Drug Financial Assistance Programme', aiming to benefit different segments of breast cancer patients and encouraging them to actively fight against TNBC breast cancer."

Dr. CHENG Chi-Kin, Ashley, clinical oncologist who have years of experience in the Hospital Authority and former Chairman of the Cancer Services Central Committee before his retirement, has been devoted to addressing the issue of drug affordability for patients. He stated, "Apart from enlisting innovative cancer drugs for the Hospital Authority and discussing patient assistance programmes with different stakeholders, I recognised that the middle-class, representing 'the sandwiched population', may not necessarily benefit from publicly funded drug financial assistance programmes. Hence, I am delighted to see the launch of the 'Immunotherapy Drug Financial Assistance Programme' that benefits patients using both public and private healthcare services." He described this initiative as providing hope for breast cancer patients from different socioeconomic backgrounds and called for joint efforts from the government, medical sector, and business sector to support patients in public and private institutions.

For more information about the "Immunotherapy Drug Financial Assistance Programme" application details, please visit the Hong Kong Breast Cancer Foundation website.

Photo link: https://drive.google.com/drive/folders/15hg_7wg7sBZH5nbAa4QeiimRQiGi8kwY?usp=sharing

About Hong Kong Breast Cancer Foundation

The Hong Kong Breast Cancer Foundation was established on March 8, 2005, making it the first non-profit charitable organization in Hong Kong dedicated to breast health education, patient support, research, and advocacy. Its mission is to reduce the threat of breast cancer in the local community. The foundation aims to raise public awareness of breast cancer and promote the importance of breast health, support breast cancer patients on their journey to recovery, and advocate for improvements in breast cancer prevention, control, and medical care in Hong Kong.