[Triple negative breast cancer: Current status and perspectives]

Abstract

Triple negative breast cancer (TNBC) is defined by the absence of expression of estrogen and progesterone receptors, as well as the absence of overexpression of HER2. Accounting for 10 to 15% of breast cancers, it remains characterized by an aggressive phenotype with an increased risk of early recurrence and overall survival less favorable compared to other subtypes. The challenges in management and therapeutic evolution are likely related to the demonstrated high biological heterogeneity of this subtype. Regarding therapeutic management, chemotherapy remains the cornerstone of TNBC treatment. In the early stage, the neoadjuvant strategy is the standard, allowing adaptation of the adjuvant sequence depending on whether a complete histological response is achieved or not. Dose-dense chemotherapy regimens and the addition of carboplatin have been associated with an improvement in these response rates. Furthermore, immunotherapy, particularly pembrolizumab, has shown significant benefits in terms of recurrence-free survival. In the metastatic setting, the role of theranostic markers is now established, allowing access to immunotherapy (pembrolizumab if CPS PD-L1>10%) or PARP inhibitors (in case of constitutional BRCA mutation). Antibody-drug conjugates are gradually moving up the lines, offering promising prospects in these complex situations. In conclusion, despite recent progress, TNBC remains a major clinical challenge. A better understanding of its biology and a personalized therapeutic approach are essential to improve clinical outcomes for patients with this aggressive form of breast cancer.

Keywords: Antibody–drug conjugate; Anticorps conjugué; Breast cancer; Cancer du sein; Chimiothérapie; Immune check point inhibitors; Immunothérapie; Inhibiteur de PARP; PARP inhibitor; Triple negative; Triple négatif.