Triple negative breast cancer (TNBC) is a heterogeneous disease comprising different orphan breast cancers and defined simply by the absence of ER, PR and HER-2. Approximately 15%-20% of breast cancers exhibit this phenotype, which is characterised by distinct risk factors and molecular features, and a particular clinical presentation and outcome. These features are discussed in the current review. The risk of developing TNBC varies with age, race, genetics, and reproductive factors such as parity and breastfeeding patterns. Loco-regional treatment is often performed after upfront systemic treatment in order to increase breast conservation rates. Similar to other invasive breast cancer subtypes, this involves surgery with or without adjuvant radiotherapy. Some TNBC are very chemo-sensitive and the majority of patients will never relapse. A high density of tumor infiltrating lymphocytes and specific histological subgroups of TNBC can indicate a good prognosis, even in the absence of chemotherapy. Distinct molecular subgroups within TNBC such as the luminal androgen receptor positive subtype have also been defined.
When metastatic relapse does occur in TNBC cases, it is usually within 3 years of surgery and patient survival following relapse is shorter compared to other breast cancer subtypes. Some new treatment options have proven effective, including the AB-drug conjugate against TROP2, PARP inhibitors in cases of homologous recombination deficiency, and immune checkpoint blockade if there is PD-L1 expression. However, successful treatments remain rare and responses often lack durability. Novel drug targets, new biomarkers and further molecular and biological investigations of TNBC are needed to improve care for breast cancer patients presenting with this subtype.
This special issue of EJGO on the management of early- and late-stage TNBC serves to update the reader on this important topic.
Prof. Patrick Neven
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