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Review
. 2025 Aug 15.
doi: 10.1159/000547988. Online ahead of print.

New Perspectives in the Management of Triple-Negative Breast Cancer

Rupert Bartsch  1   2 , Zsuzsanna Bago-Horvath  2   3 , Daniel Egle  2   4 , Simon P Gampenrieder  5 , Birgit Grünberger  6 , Sonja Heibl  7 , Maximilian Marhold  1 , Caroline Preuss  8 , Gabriel Rinnerthaler  2   9 , Kathrin Strasser-Weippl  10 , Christoph Suppan  2   9 , Christian F Singer  2   11 , Michael Gnant  2   12
Affiliations
Review

New Perspectives in the Management of Triple-Negative Breast Cancer

Rupert Bartsch et al. Breast Care (Basel). .

Abstract

Background: The biological heterogeneity of triple-negative breast cancer (TNBC) and the availability of a growing number of therapeutic options necessitate continuous redefinition of the ideal treatment algorithm for patients with TNBC. Austrian experts convened for an advisory board meeting in November 2024 to discuss standards of care in the early and metastatic settings with a focus on the healthcare situation in Austria.

Summary: This paper discusses biological principles, (neo)adjuvant treatment standards and strategies of escalation and de-escalation, as well as standards of care, new treatment options, and the management of central nervous system (CNS) disease in the setting of metastatic TNBC.

Key messages: TNBC remains a high-risk subtype of breast cancer. Neoadjuvant chemotherapy is preferred in early-stage disease starting from cT1c, cN0, with the addition of pembrolizumab recommended from clinical stage II. Post-neoadjuvant treatment is guided by the pathological response and BRCA mutation status, while ongoing trials are evaluating the role of antibody-drug conjugates in this setting. In metastatic TNBC, assessment of PD-L1 expression and BRCA mutation status is essential for optimal sequencing of available treatment options. CNS involvement remains a major clinical challenge.

Keywords: Diagnosis; Treatment; Triple-negative breast cancer recommendations.

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Conflict of interest statement

Rupert Bartsch received honoraria for advisory role from AstraZeneca, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, Grünenthal, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Seagen, and Stemline; lecture honoraria from Amgen, AstraZeneca, BMS, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, Grünenthal, MSD, MedMedia, Novartis, Pfizer, Pierre Fabre, Roche, Seagen, and Stemline; and research support from Daiichi Sankyo. Zsuzsanna Bago-Horvath received lecture honoraria from MSD, AstraZeneca, Gilead, and AbbVie; and honoraria for advisory role from MSD, AstraZeneca, Daiichi Sankyo, Stemline, Gilead, and AbbVie. Daniel Egle received honoraria from Roche, Daiichi Sankyo, Seagen, Novartis, Menarini, AstraZeneca, Pfizer, Gilead, Eli Lilly, Sirius Medical, and MSD; travel support from Pfizer, Daiichi Sankyo, Menarini, and Gilead; and a research grant from Sirius Medical. Simon P. Gampenrieder received honoraria from Roche, Daiichi Sankyo, Seagen, Novartis, BMS, AstraZeneca, Pfizer, Janssen, Gilead, Eli Lilly, and MSDM; travel support from Roche, Amgen, Novartis, Pfizer, Bayer, Celgene, Daiichi Sankyo, Janssen, and Gilead; and a research grant from Roche, Daiichi Sankyo, Novartis, Pfizer, Caris Life Sciences, Lilly, Seagen, Gilead, AstraZeneca, and Stemline Therapeutics. Birgit Grünberger received honoraria from MSD, BMS, Eli Lilly, Roche, Bayer, Servier, AstraZeneca, Amgen, Daiichi Sankyo, Pierre Fabre, Incyte, Merck, Novartis, BeiGene, Takeda, and Jazz Pharma. Sonja Heibl received honoraria from Novartis, Lilly, AstraZeneca, Gilead, Daiichi Sankyo, GSK, and Roche. Maximilian Marhold received honoraria for lectures, writing, and advisory board participation and consultation from Roche, Gilead, Eli Lilly, Novartis, AstraZeneca, Daiichi Sankyo, Pfizer, MSD, and MedMedia; travel support from Amgen, Gilead, Roche, Novartis, Pierre Fabre, MSD, Daiichi Sankyo, and Eisai as well as research support from Daiichi Sankyo. Caroline Preuss received honoraria from MSD, AstraZeneca, Daiichi Sankyo, and Gilead; and travel support from MSD and Daiichi Sankyo. Gabriel Rinnerthaler received honoraria from AstraZeneca, BMS, Daiichi Sankyo, Eli Lilly, Gilead, MSD, Novartis, Roche, Seagen, and Stemline; consulting or advisory role from AstraZeneca, Daiichi Sankyo, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, and Stemline; travel support from Daiichi Sankyo, Gilead, Roche, and Servier; and a research grant (institutional) from AstraZeneca, Daiichi Sankyo, and Stemline. Kathrin Strasser-Weippl received honoraria from Roche, Pfizer, Novartis, Lilly, Daiichi Sankyo, Myriad, Seagen, MSD, AstraZeneca, and Gilead; and travel support from Roche, Pfizer, MSD, Novartis, Lilly, and MSD. Christoph Suppan received honoraria from Roche, Novartis, Pfizer, Eli Lilly, AstraZeneca, Gilead, Daiichi Sankyo, Pierre Fabre, Stemline, and Menarini; and travel support from Roche, Novartis, Pfizer, Astellas, AstraZeneca, Daiichi Sankyo, and Pierre Fabre. Christin F. Singer received travel grant speaker honoraria and research grants from Novartis, AstraZeneca, Amgen, Gilead, Streamline/Menarini, MSD, and Pfizer. Michael Gnant reports personal fees/travel support from Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Eli Lilly, EPG Health (IQVIA), Menarini-Stemline, MSD, Novartis, Pierre Fabre, and Veracyte. Rupert Bartsch, Zsuzsanna Bago-Horvath, Daniel Egle, Gabriel Rinnerthaler, Christian F. Singer, and Michael Gnant were members of the journal’s Editorial Board at the time of submission.

Figures

Fig. 1.
Fig. 1.
Algorithm in patients with suspected CNS metastases (according to EANO-ESMO 2021 [31]).
See this image and copyright information in PMC

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