Treatment Landscape for Triple-Negative Breast Cancer
Expert perspectives on the treatment landscape for triple-negative breast cancer and the evolving role of immunotherapy in this space.
This is a synopsis of an OncView series featuring Sara M. Tolaney, MD, MPH, of Dana-Farber Cancer Institute.
Sara M. Tolaney, MD, MPH, Chief of Breast Oncology at Dana-Farber Cancer Institute, discussed advances in triple-negative breast cancer (TNBC). In early-stage TNBC, the KEYNOTE-522 trial added pembrolizumab to neoadjuvant chemotherapy, continued post-surgery. This regimen improved pathologic complete response and event-free survival, becoming standard preoperative therapy. Residual disease guides adjuvant approaches, often chemotherapy with continued pembrolizumab based on response. Ongoing trials optimize residual disease treatment.
In metastatic TNBC, Dr. Tolaney first determines PD-L1, HER2-low, and germline BRCA status to guide sequencing:
- PD-L1 positive: 1st-line pembrolizumab + chemotherapy
- PD-L1 negative: chemotherapy
- 2nd-line: antibody-drug conjugate sacituzumab govitecan (SG)
If HER2-low, trastuzumab deruxtecan (T-DXd) is an option after SG based on DESTINY-Breast04, though evidence is lower than for SG from the ASCENT trial.
For germline BRCA mutations, a PARP inhibitor replaces chemotherapy in the 1st-line or 2nd-line setting.
In summary, immunotherapy and antibody-drug conjugates have transformed metastatic TNBC treatment. Biomarker analyses determine optimal personalized therapy based on PD-L1, HER2-low, and BRCA status. In the early setting, pembrolizumab with chemotherapy is now standard-of-care with studies underway to refine management of residual disease after this regimen.
*Video synopsis is AI-generated and reviewed by Cancer Network editorial staff.
