Current Treatment Landscape for Early Triple-Negative Breast Cancer (TNBC)

Abstract

Triple-negative breast cancer (TNBC) accounts for 15–20% of all breast cancers and is characterized by an aggressive nature and a high rate of recurrence despite neoadjuvant and adjuvant chemotherapy. Although novel agents are constantly being introduced for the treatment of breast cancer, conventional cytotoxic chemotherapy based on anthracyclines and taxanes is the mainstay treatment option for TNBC. Based on CTNeoBC pooled analysis data, the achievement of pathologic CR (pCR) in TNBC is directly linked to improved survival outcomes. Therefore, the treatment paradigm for early TNBC has shifted to neoadjuvant treatment, and the escalation of neoadjuvant chemotherapy to improve the pCR rate and the addition of post-neoadjuvant chemotherapy to control the residual disease have been investigated. In this article, we review the current treatment landscape for early TNBC, from standard cytotoxic chemotherapy to recent data on immune checkpoint inhibitors, capecitabine, and olaparib.

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“…2 Although different chemotherapy regimens have been developed based on grading systems and pathological diagnoses, clinical treatment of TNBC has long suffered from chemoresistance and relapse. [3][4][5][6] BC, especially TNBC, is a highly heterogeneous malignancy where the complexity of genotype and phenotype determines protein expression, metabolic mechanisms, tumor microenvironment, and ultimately the sensitivity to chemotherapy varying in distinct cell subsets. [7][8][9][10] Therefore, the precision of treatment is considered to meet the challenge of tumor heterogeneity.…”

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“…The combination of pembrolizumab plus anthracycline, platinum agents, and taxane as a neoadjuvant regiment is the current standard approach for TNBC, followed by the individualized response or the BRCA gene testing results. It will eventually lead to much complex choices involving olaparib (and its derivatives from poly adenosine diphosphate (ADP) ribose polymerase (PARP) inhibitors), or other immune checkpoint inhibitors (ICIs), e.g., nivolumab, atezolizumab, etc., serving the role of personalized treatment in modern oncology [ 77 , 78 ]. Despite the advancement of those classes as a whole, further exploration revealed that their administration was only effective on specific individuals, as determined by the BRCA status and the programmed death-ligand 1 (PD-L1) expressivity.…”

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“…Therefore, based on the available evidence, platinum-based chemotherapy regimens are not routinely recommended. The regimens could be considered only in patients with high-risk factors such as BRCA mutations ( 90 ).…”