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Advances in systemic therapies for triple negative breast cancer
The BMJ ( IF 105.7 ) Pub Date : 2023-05-30 , DOI: 10.1136/bmj-2022-071674
Roberto A Leon-Ferre 1 , Matthew P Goetz 1
Affiliation  

Triple negative breast cancer (TNBC) continues to be the subtype of breast cancer with the highest rates of recurrence and mortality. The lack of expression of targetable proteins such as the estrogen receptor and absence of HER2 amplification have made relying on cytotoxic chemotherapy necessary for decades. In the operable setting, efforts to improve outcomes have focused on escalation of systemic therapy and a shift toward preoperative delivery followed by a response adapted approach to postoperative systemic therapy. An improved understanding of tumor biology has resulted in the identification of subsets of patients with specific molecular features, leading to testing and approval of multiple new targeted therapies for this disease. Furthermore, advances in drug development have led to the approval of antibody-drug conjugates that are redefining classification schemes for breast cancer. This review focuses on the modern management of TNBC, with particular focus on recent updates in the treatment of operable disease, and an overview of the most recent promising advances in the therapeutic landscape of metastatic disease. It discusses the practical challenges and unanswered questions resulting from the approval of neoadjuvant immunotherapy and shares an approach in the clinic on topics for which evidence is lacking. In addition, it provides a glimpse into the future, highlighting challenges and opportunities for biomarker based right-sizing of preoperative therapy, refining evaluation of response to preoperative therapy after surgery, early diagnosis and detection of relapse, and areas of needed research for metastatic TNBC.

中文翻译:

三阴性乳腺癌的全身治疗进展

三阴性乳腺癌(TNBC)仍然是复发率和死亡率最高的乳腺癌亚型。由于雌激素受体等靶向蛋白表达的缺乏以及 HER2 扩增的缺乏,使得几十年来必须依赖细胞毒性化疗。在可手术环境中,改善结果的努力集中在全身治疗的升级和向术前分娩的转变,然后对术后全身治疗采取适应反应的方法。对肿瘤生物学的进一步了解导致了具有特定分子特征的患者亚群的识别,从而导致对该疾病的多种新的靶向疗法进行测试和批准。此外,药物开发的进步导致抗体药物偶联物获得批准,从而重新定义乳腺癌的分类方案。本综述重点关注 TNBC 的现代管理,特别关注可手术疾病治疗的最新进展,并概述转移性疾病治疗领域的最新有希望的进展。它讨论了新辅助免疫疗法批准所带来的实际挑战和未解答的问题,并就缺乏证据的主题分享了临床方法。此外,它还提供了对未来的一瞥,强调了基于生物标志物的正确术前治疗规模的挑战和机遇,完善手术后术前治疗反应的评估,早期诊断和复发检测,以及转移性 TNBC 需要研究的领域。
更新日期:2023-05-30
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