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Review
. 2011 Feb;125(3):627-36.
doi: 10.1007/s10549-010-1293-1. Epub 2010 Dec 15.

Triple negative breast cancer: unmet medical needs

Sumanta Kumar Pal  1 , Barrett H Childs, Mark Pegram
Affiliations
Review

Triple negative breast cancer: unmet medical needs

Sumanta Kumar Pal et al. Breast Cancer Res Treat. 2011 Feb.

Abstract

Triple negative breast cancer (TNBC) is an aggressive clinical phenotype characterized by lack of expression (or minimal expression) of estrogen receptor (ER) and progesterone receptor (PR) as well as an absence of human epidermal growth factor receptor-2 (HER2) overexpression. It shows substantial overlap with basal-type and BRCA1-related breast cancers, both of which also have aggressive clinical courses. However, this overlap is not complete, and the expression of ER, PR, and HER2 has been noted in basal-like tumors. TNBC also includes the normal-like subtype, and not all patients with TNBC harbor BRCA1 mutations. Because of its expression profile, TNBC is not amenable to treatment with hormone therapy or the anti-HER2 monoclonal antibody trastuzumab, and systemic treatment options are currently limited to cytotoxic chemotherapy. Overall survival, whether in early-stage or advanced disease, is poor compared with that in patients who have other phenotypes. A number of targeted approaches to TNBC are undergoing clinical evaluation, including the use of agents with poly(ADP-ribose) polymerase inhibitory properties such as iniparib (the United States Adopted Name for the investigational agent BSI-201), olaparib (AZD2281), and veliparib (ABT-888), antiangiogenic agents such as bevacizumab and sunitinib, and epidermal growth factor receptor blockers such as cetuximab and erlotinib. Encouraging results with some of these agents have been reported, thereby offering the promise for improved outcomes in patients with TNBC. The clinical characteristics of TNBC and clinical experience to date with novel targeted agents under development for this aggressive phenotype is reviewed.

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Figures

Fig. 1
Fig. 1
Comparison of overall survival by disease stage for women with triple negative breast cancer (TNBC) and those with other phenotypes Adapted from Bauer et al [8]
Fig. 2
Fig. 2
Schematic illustration of overlap among triple negative breast cancer (TNBC), basal-like, and BRCA1-related tumors Adapted from Pal et al [28]
Fig. 3
Fig. 3
Overall survival in women with triple negative breast cancer (TNBC) compared with non-TNBC based on response to neoadjuvant cytotoxic chemotherapy. RD indicates residual disease Adapted from Liedtke et al [51]
See this image and copyright information in PMC

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