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Review
. 2020 Jun;15(3):217-226.
doi: 10.1159/000508759. Epub 2020 Jun 2.

Optimal Systemic Treatment for Early Triple-Negative Breast Cancer

Jenny Furlanetto  1 , Sibylle Loibl  1
Affiliations
Review

Optimal Systemic Treatment for Early Triple-Negative Breast Cancer

Jenny Furlanetto et al. Breast Care (Basel). 2020 Jun.

Abstract

Background: Approximately 10-15% of all breast tumors are triple-negative breast cancer (TNBC). TNBC have a higher risk of relapse and distant metastases compared to other subtypes. The optimal systemic management of TNBC according to national and international guidelines is discussed herein.

Summary: Anthracycline/taxane-based chemotherapy for patients with TNBC either in the neoadjuvant (NACT) or the adjuvant setting is considered standard of care. Exceptions are small tumors and a low-risk histology, in which chemotherapy can be spared. Dose-dense therapy is more effective in preventing recurrence and increasing survival. The use of nab-paclitaxel instead of a solvent-based taxane can lead to higher pathological complete response (pCR) rates and better outcomes. Platinum agents are effective in increasing pCR when added to anthracycline/taxane-based chemotherapy at the cost of increased toxicity. Long-term outcome data are lacking. In patients without a pCR, capecitabine leads to improved outcomes.

Key messages: The standard treatment approach of TNBC is anthracycline/taxane-based chemotherapy, preferably within the NACT setting. Dose-dense schedules as well as platinum should be considered in the NACT setting. For patients without a pCR, capecitabine is an option to improve the outcome. The role of nab-paclitaxel is under debate. In case of immunogenic tumors, checkpoint inhibitors are promising new agents that merit further investigation.

Keywords: Early breast cancer; Guidelines; Treatment; Triple-negative breast cancer.

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Conflict of interest statement

The authors declare no conflict of interests.

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