Abstract
Simple SummaryTriple negative breast cancer (TNBC) represents 15 to 20% of all breast cancers in the United States. The main treatment option remains chemotherapy, despite limited efficacy. New biologic and targeted agents are increasingly emerging for the treatment of TNBC. Given the continuous advances in the field of TNBC, this review assesses the latest developments in basic characterization, subtyping, and treatment of TNBC, including novel drug developments with antibody-drug conjugates, immune checkpoint inhibitors, PARP inhibitors, and androgen receptor targeted agents.Breast cancer (BC) is the most common malignancy affecting women. It is a highly heterogeneous disease broadly defined by the differential expression of cell surface receptors. In the United States, triple negative breast cancer (TNBC) represents 15 to 20% of all BC. When compared with other subtypes of BC, TNBC tends to present in younger women, and has a higher mortality rate of 40% in advanced stages within the first 5 years after diagnosis. TNBC has historically had limited treatment options when compared to other types of BC. The mainstay of treatment for TNBC remains cytotoxic chemotherapy despite the emergence of new biologic and targeted agents. Defining the specific tumor molecular profile including PDL-1 and androgen receptor testing is expanding treatment options in the clinical setting. Identifying more targetable, novel biomarkers that may better define therapeutic targets or prognostic markers is currently underway. TNBC nomenclature is expected to be updated in favor of other nomenclature which would help direct therapy, and further redefine TNBC’s heterogeneity. Given the continuous advances in the field of TNBC, this review assesses the latest developments in basic characterization, subtyping, and treatment of TNBC, including novel drug developments with antibody-drug conjugates, immune checkpoint inhibitors, PARP inhibitors and androgen receptor targeted agents. Future trials are necessary in the face of these innovations to further support the use of new therapies in TNBC and the detection of the appropriate biomarkers.
Highlights
Breast cancer (BC) is the most common malignancy affecting women
The drug was first approved by the United States Food and Drug Administration (FDA) in April 2020 after showing an Objective Response Rate (ORR) of 33%, a median progression free survival (PFS) of 5.5 months and an overall survival (OS) of 13 months in a phase 1–2 single-group basket trial (IMMU-132-01) [44]
The FDA has approved the use of olaparib and talazoparib in metastatic BC and many emerging studies are evaluating the potential role of PARPis in “BRCA-like” triple negative breast cancer (TNBC) with homologous recombination (HR) deficiency
Summary
Breast cancer (BC) is the most common malignancy affecting women. It is a highly heterogeneous disease, encompassing several BC molecular subtypes, broadly defined by the differential expression of cell surface receptors. BC common intrinsic molecular subtypes include Luminal A, Luminal B, and Her overexpressing, and basal cell tumors, further stratified into special subtypes [2]. When compared with other subtypes of BC, TNBC tends to present in younger women, and has a higher mortality rate of 40% in advanced stages within the first 5 years after diagnosis [4,5]. Residual micro-metastatic disease following neoadjuvant chemotherapy in TNBC is associated with an increased risk of tumor recurrence, with limited options for conventional postoperative adjuvant chemotherapy. Given the continuous advances in the field of TNBC, this review assesses the latest developments in basic characterization, subtyping, and treatment of TNBC, including novel drug developments with antibody-drug conjugates, immune checkpoint inhibitors, PARP inhibitors, and androgen receptor targeted agents
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