Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease.

Bianchini G, Balko JM, Mayer IA, Sanders ME, Gianni L
Nat Rev Clin Oncol. 2016 13 (11): 674-690

PMID: 27184417 · PMCID: PMC5461122 · DOI:10.1038/nrclinonc.2016.66

Chemotherapy is the primary established systemic treatment for patients with triple-negative breast cancer (TNBC) in both the early and advanced-stages of the disease. The lack of targeted therapies and the poor prognosis of patients with TNBC have fostered a major effort to discover actionable molecular targets to treat patients with these tumours. Massively parallel sequencing and other 'omics' technologies have revealed an unexpected level of heterogeneity of TNBCs and have led to the identification of potentially actionable molecular features in some TNBCs, such as germline BRCA1/2 mutations or 'BRCAness', the presence of the androgen receptor, and several rare genomic alterations. Whether these alterations are molecular 'drivers', however, has not been clearly established. A subgroup of TNBCs shows a high degree of tumour-infiltrating lymphocytes that also correlates with a lower risk of disease relapse and a higher likelihood of benefit from chemotherapy. Proof-of-principle studies with immune-checkpoint inhibitors in advanced-stage TNBC have yielded promising results, indicating the potential benefit of immunotherapy for patients with TNBC. In this Review, we discuss the most relevant molecular findings in TNBC from the past decade and the most promising therapeutic opportunities derived from these data.

MeSH Terms (17)

Androgen Antagonists Biomarkers, Tumor BRCA2 Protein Clinical Trials as Topic Female Humans Immune System Immunotherapy Mitogen-Activated Protein Kinases Molecular Targeted Therapy Mutation Neoplastic Stem Cells Phosphatidylinositol 3-Kinases Poly(ADP-ribose) Polymerase Inhibitors Prognosis Triple Negative Breast Neoplasms Ubiquitin-Protein Ligases

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