Facing the conundrum: which first-line therapy should be used for patients with metastatic triple-negative breast cancer carrying germline BRCA mutation?

Abstract

Pembrolizumab combined with chemotherapy has been establishedãs the preferred first-line therapy for treating metastatic triple-negative breast cancer (mTNBC) with programmed cell death ligand-1 (PD-L1)- positive disease since itsãpproval for that indication. However, the optimal sequencing of therapy remainsãn unanswered question forã subset of mTNBC patients who harbor germline breast cancer gene 1/2 (BRCA1/2; gBRCA1/2) mutation. Thisãrticleãims to offer insights into the optimal therapy sequencing for mTNBC patients with gBRCA1/2 mutationsãnd its impact on clinical decision-making. The perspective offered is based on the best currentlyãvailable dataãnd proposeã practicalãlgorithm to guide the management of this subgroup in the frontline setting.