Onkológia 5/2022

Advances in the treatment of triple- negative breast cancer

Triple negative breast cancer (TNBC) is an aggressive tumor linked to poorer prognosis and fast spreading. Patients in the early stage of the disease may profit from neoadjuvant chemotherapeutic regimens including anthracyclines, taxanes, and alkylating agents. Adjuvant treatment with capecitabine is proposed in the case of unachieved pathological complete response (pCR) after neoadjuvant treatment and surgery. The likelihood of reaching pCR in patients with early stage, high- risk TNBC is raised by adding pembrolizumab to neoadjuvant chemotherapy, followed by adding pembrolizumab in adjuvant treatment as a single agent. Metastatic TNBC (mTNBC) is characterised by a high tumor mutational burden, presence of tumor infiltrating lymphocytes, and expression of the TROP 2 antigen, which ultimately enables the use of targeted treatment. Management of mTNBC includes chemotherapy, immune checkpoint inhibitors, inhibitors of poly adenosine diphosphate- ribose polymarase (iPARP) and antibody- drug conjugates in case of refractory mTNBC. The optimal choice for the therapeutic strategy is based on several factors, such as stage of the disease, theragnostic markers (PD-L1, germline mutation in BRCA 1/2 gens), patients performance status and comorbidities.

Keywords: triple negative breast cancer, neoadjuvant therapy, PARP inhibitors, immunotherapy, antibody- drug conjugates