(Seek Help) Long Term Luminal A BC transformed into TNBC (Surgery done and under chemo)

Hello, I am so sorry to read this. The concern, love and care for your mum can be seen very clearly in your post. 
I think that your questions focus on your mums TNBC diagnosis? There are lots of people on this forum with experience of treatments for this breast cancer type, and I am sure that they will come forward soon with much more informed replies than I can give you. Treatments for TNBC have advanced in recent years. There is much more available to oncologists than there was previously, and that gives hope. My limited understanding of targeted treatments is that oncologists will test for any relevant genes/mutations so as to administer the right treatment, at that time. Well, that is what I was told by my oncologist, but perhaps you could ask that question of your mums oncologist? Your mums response does suggest that she is quite well informed on this. And she is right that approaches are moving forward all the time, and that does inform things. 
Hopefully someone with more knowledge than myself will come forward soon. X 

I have metastatic TNBC, PD-L1 positive. I have familiarity with UK treatment protocols. You mention Shanghai, protocols worldwide may not be the same.

You ask about BRCA, HRD, PD-L1.  In the UK, testing wouldn’t normally be done for genetic mutations such as BRCA 1/2 unless the patient was under 60 or had a strong family history of breast cancer. PD-L1 wouldn’t normally be tested unless the tumour was grade 3 and either greater than 2mm or with lymph node involvement, or with evidence of metastatic spread. This is because Pembrolizumab only has 2 treatment authorisations for breast cancer the UK - one for metastatic PD-L1 positive TNBC, and 1 for neoadjuvant treatment of higher risk early stage PD-L1 positive TNBC tumours, as described above. 

Reading what you have written, I think treatment in the UK would likely be 4 cycles of EC and 4 cycles of Paclitaxel (12 weeks). The UK more commonly uses epirubicin (the E in EC) rather than Adriamycin (the A) but they are very similar drugs. So your mum’s treatment looks to be what I would expect. You mention she might move onto targeted therapy but the targeted therapies used in ER+ and HER+ cancers don’t work on TNBC. 

Thank you for all the kind words. I really appreciate. My mom's such a strong and brave woman that I would admire her in my whole life. I just hope I can do something for her, for example maybe English forum has more information I could gather. I made a mistake in the previous post which I now corrected. My mom would probably proceed to immunotherapy rather than targeted therapy after chemo, according to her doctor. Yes we all need to hold hope. I will keep hunting. Thank you for your voice. I also hope everything good will happen for you as well.

Hi I want to thank you for all the information you shared, which I appreciate so much. I hope you are doing all great and will have a swift recovery soon. I know if you are positive in PD-L1 you can use tailored K medicine. I hope that is helping you powerfully. This is also why I have such concern of taking gene tests or not. I am thinking if she's diagnosed with specific type she may have more tailored treatment. I made a typo in the previous post and now have corrected it. My mom's going to undergo immunotherapy rather that targeted therapy according to her doctor, after chemo. I also heard TNBC patients are not necessarily avoiding targeted therapy, which depends on further results of gene tests.

My mom's white blood cell count dropped to around 2.x after her first chemotherapy session. The doctor gave her a G-CSF injection to boost it. I’m a bit worried about the potential impact on her bone marrow, so I’m planning to focus heavily on her diet, hoping to raise her WBC naturally through nutrition. The doctor hasn't given us a fixed chemo schedule yet. I suspect he wants to stay flexible since there's no guarantee how effective the AC protocol will be for her. We may need to dynamically adapt. 

Immunotherapy such as pembro can work very well. It can also cause significant damage to healthy organs if the immune system reacts highly to it. Sort of good and bad together. I achieved remission but also had an acute kidney injury, lost my thyroid function and got lung damage. As a metastatic patient it was really my only hope - but on a just in case basis, the decision isn’t so straightforward. Wishing her, and you, well. 

I had the G-CSF stimulators alongside EC. Caused a lot of bone pain but keeps my neutrophil count high. 

Hi I am very happy to hear you achieved remission! while so sorry for the unexpected damage to your other organs. I appreciate your advice, indeed this is a decision worth considering over and over. I will do my investigation and be conscious with my mom's choice. 

That is exactly part of reason why I want to try my best to avoid G-CSF in the future. It's kind like overdraft. Also I heard it may cause Myelosuppression.