Castellano Grazia, Giugliano Federica, Curigliano Giuseppe, Marra Antonio
Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Curr Opin Oncol. 2023 Nov 1;35(6):479-490. doi: 10.1097/CCO.0000000000000989. Epub 2023 Aug 21.
This comprehensive review aims to provide timely and relevant insights into the current therapeutic landscape for triple-negative breast cancer (TNBC) and the molecular features underlying this subtype. It emphasizes the need for more reliable biomarkers to refine prognostication and optimize therapy, considering the aggressive nature of TNBC and its limited targeted treatment options.
The review explores the multidisciplinary management of early TNBC, which typically involves systemic chemotherapy, surgery, and radiotherapy. It highlights the emergence of immune checkpoint inhibitors (ICIs), poly(ADP-ribose) polymerase (PARP) inhibitors, and antibody-drug conjugates (ADCs) as promising therapeutic strategies for TNBC. Recent clinical trials investigating the use of ICIs in combination with chemotherapy and the approval of pembrolizumab and atezolizumab for PD-L1-positive metastatic TNBC are discussed. The efficacy of PARP inhibitors and ADCs in treating TNBC patients with specific genetic alterations is also highlighted.
The findings discussed in this review have significant implications for clinical practice and research in TNBC. The identification of distinct molecular subtypes through gene expression profiling has enabled a better understanding of TNBC heterogeneity and its clinical implications. This knowledge has the potential to guide treatment decisions, as different subtypes display varying responses to neoadjuvant chemotherapy. Furthermore, the review emphasizes the importance of developing reliable genomic and transcriptomic signatures as biomarkers to refine patient prognostication and optimize therapy selection in TNBC. Integrating these signatures into clinical practice may lead to more personalized treatment approaches, improving outcomes for TNBC patients.
本全面综述旨在及时提供有关三阴性乳腺癌(TNBC)当前治疗格局及其潜在分子特征的相关见解。考虑到TNBC的侵袭性本质及其有限的靶向治疗选择,强调需要更可靠的生物标志物来完善预后评估并优化治疗。
该综述探讨了早期TNBC的多学科管理,通常包括全身化疗、手术和放疗。它强调免疫检查点抑制剂(ICI)、聚(ADP - 核糖)聚合酶(PARP)抑制剂和抗体 - 药物偶联物(ADC)作为TNBC有前景的治疗策略的出现。讨论了近期研究ICI与化疗联合使用的临床试验以及帕博利珠单抗和阿特珠单抗获批用于PD - L1阳性转移性TNBC的情况。还强调了PARP抑制剂和ADC在治疗具有特定基因改变的TNBC患者中的疗效。
本综述中讨论的发现对TNBC的临床实践和研究具有重要意义。通过基因表达谱鉴定不同的分子亚型有助于更好地理解TNBC的异质性及其临床意义。这些知识有可能指导治疗决策,因为不同亚型对新辅助化疗表现出不同的反应。此外,该综述强调开发可靠的基因组和转录组特征作为生物标志物以完善TNBC患者预后评估并优化治疗选择的重要性。将这些特征整合到临床实践中可能会带来更个性化的治疗方法,改善TNBC患者的治疗结果。