From the Guidelines
Triple negative breast cancer is a type of breast cancer that lacks three key receptors: estrogen receptors, progesterone receptors, and HER2 protein, and is typically treated with surgery, chemotherapy, and radiation therapy, with newer treatments including immunotherapy and PARP inhibitors for certain patients. This type of breast cancer accounts for about 10-15% of all breast cancers and tends to be more aggressive, growing and spreading faster than other types. It is more common in women under 40, Black women, and those with BRCA1 gene mutations. According to the most recent study 1, treatment recommendations for triple-negative breast cancer have remained largely unchanged, with a focus on chemotherapy regimens such as anthracyclines and taxanes, and the use of dose-dense therapies. Additionally, patients with BRCA1/2 mutations may be eligible for adjuvant therapy with olaparib. The lack of targeted receptors makes treatment more challenging, but research continues to advance with clinical trials exploring new approaches, including antibody-drug conjugates like sacituzumab govitecan (Trodelvy). Some studies have also shown that immunotherapy, such as atezolizumab or pembrolizumab, may be effective in combination with chemotherapy for patients with PD-L1-positive tumors 1.
Some key characteristics of triple negative breast cancer include:
- Higher risk of recurrence within 3 years of diagnosis
- Increased mortality rates for 5 years after diagnosis
- Association 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
- More common in women under 40, Black women, and those with BRCA1 gene mutations
Treatment options for triple negative breast cancer may include:
- Surgery
- Chemotherapy (such as anthracyclines, taxanes, and platinum agents)
- Radiation therapy
- Immunotherapy (like Keytruda/pembrolizumab) for PD-L1 positive tumors
- PARP inhibitors (such as olaparib or talazoparib) for patients with BRCA mutations
- Antibody-drug conjugates like sacituzumab govitecan (Trodelvy)
From the Research
Definition of Triple Negative Breast Cancer
- Triple negative breast cancer (TNBC) is a complex and aggressive subtype of breast cancer that lacks estrogen receptors, progesterone receptors, and HER2 amplification 2, 3, 4, 5, 6.
- This subtype of breast cancer is characterized by its unique molecular profile, aggressive behavior, distinct patterns of metastasis, and lack of targeted therapies 4.
- TNBC is generally considered to have high malignancy and poor prognosis, with the highest rates of metastatic disease and the poorest overall survival of all breast cancer subtypes 2.
Characteristics of Triple Negative Breast Cancer
- TNBC is clinically negative for expression of estrogen and progesterone receptors (ER/PR) and HER2 protein 4.
- It is characterized by aggressive and metastatic phenotypes and high rates of relapse 6.
- Although not synonymous, the majority of triple-negative breast cancers carry the "basal-like" molecular profile on gene expression arrays 4.
- The majority of BRCA1-associated breast cancers are triple-negative and basal-like 4.
Treatment and Therapies
- Targeted agents, including epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and poly (ADP-ribose) polymerase (PARP) inhibitors, are currently in clinical trials and hold promise in the treatment of this aggressive disease 4, 5.
- The development of targeted therapies, as well as early diagnosis methods, is vital to ensure an adequate and timely therapeutic intervention in patients with TNBC 6.
- Novel combination therapies and emerging therapeutic modalities, such as androgen receptor (AR), PI3K/AKT/mTOR and AMPK signaling pathways, and immunotherapies, are being explored to increase response rates and circumvent drug-induced resistance 2, 3.