Bhardwaj Prarthna V, Wang Yue, Brunk Elizabeth, Spanheimer Philip M, Abdou Yara G
Division of Hematology-Oncology, University of Massachusetts Chan Medical School-Baystate, Springfield, MA 01199, USA.
Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Int J Mol Sci. 2023 Aug 5;24(15):12478. doi: 10.3390/ijms241512478.
Triple-negative breast cancer (TNBC) is a subtype of breast cancer with both inter- and intratumor heterogeneity, thought to result in a more aggressive course and worse outcomes. Neoadjuvant therapy (NAT) has become the preferred treatment modality of early-stage TNBC as it allows for the downstaging of tumors in the breast and axilla, monitoring early treatment response, and most importantly, provides important prognostic information that is essential to determining post-surgical therapies to improve outcomes. It focuses on combinations of systemic drugs to optimize pathologic complete response (pCR). Excellent response to NAT has allowed surgical de-escalation in ideal candidates. Further, treatment algorithms guide the systemic management of patients based on their pCR status following surgery. The expanding knowledge of molecular pathways, genomic sequencing, and the immunological profile of TNBC has led to the use of immune checkpoint inhibitors and targeted agents, including PARP inhibitors, further revolutionizing the therapeutic landscape of this clinical entity. However, subgroups most likely to benefit from these novel approaches in TNBC remain elusive and are being extensively studied. In this review, we describe current practices and promising therapeutic options on the horizon for TNBC, surgical advances, and future trends in molecular determinants of response to therapy in early-stage TNBC.
三阴性乳腺癌（TNBC）是乳腺癌的一种亚型，具有肿瘤间和肿瘤内的异质性，被认为会导致更具侵袭性的病程和更差的预后。新辅助治疗（NAT）已成为早期TNBC的首选治疗方式，因为它可以使乳腺和腋窝的肿瘤降期，监测早期治疗反应，最重要的是，提供重要的预后信息，这对于确定改善预后的术后治疗至关重要。它侧重于全身药物的联合使用，以优化病理完全缓解（pCR）。对NAT的良好反应使得理想候选者可以进行手术降级。此外，治疗算法根据患者术后的pCR状态指导其全身管理。对TNBC分子途径、基因组测序和免疫特征的认识不断扩展，导致了免疫检查点抑制剂和靶向药物（包括PARP抑制剂）的使用，进一步彻底改变了这一临床实体的治疗格局。然而，TNBC中最可能从这些新方法中获益的亚组仍然难以捉摸，正在进行广泛研究。在这篇综述中，我们描述了TNBC目前的治疗实践和即将出现的有前景的治疗选择、手术进展以及早期TNBC治疗反应分子决定因素的未来趋势。
