From the Guidelines
Triple negative breast cancer has a poor prognosis, with a 5-year survival rate of approximately 91% for localized disease, 65% for regional spread, and 12% for metastatic disease, and tends to be more aggressive with higher recurrence rates, particularly within the first 3-5 years after diagnosis. The prognosis of Triple Negative Breast Cancer (TNBC) is generally less favorable compared to other breast cancer subtypes, with higher mortality rates and poorer outcomes 1. According to the most recent evidence, patients with metastatic triple-negative breast cancer without expression of programmed cell death ligand-1 (PD-L1–negative) should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for symptomatic or immediately life-threatening disease 1.
Key Characteristics of TNBC
- TNBC represents 10%–20% of invasive breast cancers and has been associated with African-American race, deprivation status, younger age at diagnosis, more advanced disease stage, higher grade, high mitotic indices, family history of breast cancer and BRCA1 mutations 1
- Women with TNBC experience the peak risk of recurrence within 3 years of diagnosis, and the mortality rates appear to be increased for 5 years after diagnosis 1
- TNBC is regularly reported to be three times more common in women of African descent and in pre-menopausal women, and carries a poorer prognosis than other forms of breast cancer 1
Treatment Options
- Treatment typically involves surgery, chemotherapy (often including anthracyclines, taxanes, and platinum agents), and radiation therapy 1
- Newer treatments like immunotherapy (pembrolizumab) for PD-L1 positive tumors and PARP inhibitors (olaparib, talazoparib) for patients with BRCA mutations have improved outcomes for specific patient groups 1
- For patients with BRCA1/2 mutations, the PARP inhibitors show clear benefit, as do the older platinum agents, with olaparib and talazoparib being preferred options for patients with HER2-negative disease and germline BRCA1/2 mutations 1
Follow-up and Ongoing Research
- Regular follow-up is crucial, especially during the first five years after treatment, as early detection of recurrence can significantly impact survival 1
- Ongoing research continues to develop more effective treatments for this breast cancer subtype, with a focus on targeted therapies and immunotherapy 1
From the Research
Prognosis of Triple Negative Breast Cancer (TNBC)
- TNBC often grows rapidly and has poor outcomes, with a high recurrence rate and a short interval between recurrence and death 2
- The prognosis of TNBC remains poor due to its aggressive nature and limited treatment options 3
- TNBC is characterized by an increased risk of early recurrence and distant metastasis, as well as the development of therapeutic resistance 3
Treatment Outcomes
- Neoadjuvant chemotherapy with platinum-based regimens has been shown to be effective for TNBC and improves pathological complete response (pCR) rates 2, 4
- Platinum-based chemotherapy improves disease-free survival (DFS) and overall survival (OS) in both neoadjuvant and adjuvant settings 4
- The inclusion of platinum chemotherapy in the treatment regimen increases pCR rates, but is also associated with increased haematological toxicity 4
Future Perspectives
- New treatment strategies are being developed, including novel agents and combination therapies, to improve outcomes for TNBC patients 5, 6
- Postneoadjuvant risk-adapted treatments have demonstrated improved survival in patients at high risk of recurrence 5
- Ongoing clinical trials are investigating new approaches, including immunotherapy and targeted therapies, to address the limited treatment options for TNBC 5, 6