New Perspectives in the Management of Triple-Negative Breast Cancer

Abstract

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.