A narrative review of chemotherapy in advanced triple negative breast cancer

Abstract

Triple-negative breast cancers (TNBCs) are a heterogeneous group of aggressive tumors with high relapse rates and propensity to develop visceral or brain metastasis, representing 15% of the breast carcinomas. Their overall survival (OS) has remained static over the past 20 years. Cytotoxic chemotherapy (CT) was the only treatment option for all stages of TNBC until the first targeted therapy Olaparib was approved in patients with germline BRCA-mutation. This unsystematic narrative review is aimed at presenting an overview of the use of CT in advanced/metastatic triple-negative breast cancer (mTNBC) in these times when the personalized medicine era is slowly reaching TNBC with new therapeutic options. The information used to write it was collected from the published literature, treatment guidelines and hand searches of retrieved literature references. Standard anthracycline-based CT is the treatment of choice as first-line for metastatic breast cancer patients not previously treated with anthracyclines. First-line single-agent taxane is offered to patients who have received prior adjuvant anthracyclines or presented anthracycline failure, or as the second line in patients who have received prior anthracyclines in the metastatic setting. TNBC tumors that carry the germline BRCA1/2 mutations can benefit from the targeted use of platinum. Other drugs as eribulin, capecitabine, platinum, and gemcitabine, that have proven efficacy as single-agents or in combination as further lines, but the sequencing is not established. Combination chemotherapy can be considered when the patient presents a severe organ dysfunction aiming to achieve disease stabilization. CT remains the cornerstone treatment for mTNBC which not express targetable receptors or defective molecular pathways, and as a counterpart for targeted or immune therapies; given the limited access to these last in most countries, CT will continue in the landscape for much longer.