Breast Medicine Service, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
Oncologist. 2022 Feb 3;27(1):30-39. doi: 10.1093/oncolo/oyab003.
Triple-negative breast cancer (TNBC) accounts for approximately 15%-20% of breast cancers diagnosed worldwide, which amounts to almost 200 000 cases each year. Although historically TNBC is considered difficult to treat with a poor prognosis, there is emerging evidence showing excellent response rates in a subset of TNBC patients. Attempts to de-escalate chemotherapy in hormone-receptor-positive (HR+) and HER2-neu amplified breast cancer subtypes have been successful. At present, robust strategies to personalize therapy in early-stage TNBC do not exist, and despite excellent response rates in a subset of patients, all patients are exposed to the same several cycles of cytotoxic chemotherapy. Personalizing therapy in TNBC represents a challenge due to the scarcity of treatment options outside of cytotoxic chemotherapy and limited predictive and prognostic biomarkers to tailor treatment. Recent developments in understanding TNBC biology have sparked interest in exploring treatment optimization and personalization with the goal of achieving excellent response rates and long-term clinical outcomes, while simultaneously reducing physical, psychological, and financial toxicities for select patients. Here, we provide an update on the current evidence to support future studies examining de-escalating chemotherapy in patients with low-risk TNBC and adjuvant intensification strategies to improve outcomes for patients who are at high risk for systemic failure despite current standard-of-care treatments.
三阴性乳腺癌（TNBC）约占全球诊断出的乳腺癌的 15%-20%，每年约有 20 万例。尽管 TNBC 历来被认为难以治疗且预后不良，但有新的证据表明，在一部分 TNBC 患者中，TNBC 具有极好的响应率。尝试在激素受体阳性（HR+）和 HER2 过表达乳腺癌亚型中降低化疗强度已取得成功。目前，在早期 TNBC 中个性化治疗的策略并不完善，尽管一部分患者的响应率极好，但所有患者都接受了相同的几轮细胞毒性化疗。由于除细胞毒性化疗之外的治疗选择有限，并且缺乏用于调整治疗的预测性和预后性生物标志物，因此在 TNBC 中进行个性化治疗具有挑战性。最近对 TNBC 生物学的认识的发展激发了人们探索优化和个性化治疗的兴趣，以期实现优异的响应率和长期临床结果，同时为选择患者减轻身体、心理和经济毒性。在这里，我们提供了目前证据的更新，以支持未来研究，这些研究旨在检查低危 TNBC 患者中降低化疗强度，以及强化辅助治疗策略，以改善尽管接受当前标准治疗仍存在全身治疗失败风险的患者的结局。
