Triple negative breast cancers are most often high grade invasive ductal carcinomas which are characterised by an aggressive clinical phenotype. Triple negative breast cancer (TNBC) accounts for approximately 15% of breast cancers and is characterised by the absence of expression of the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 receptor (HER2) expression. We searched PubMed, and recent international meetings from American Society of Clinical Oncology, San Antonio Breast Cancer Conference and the European Society of Medical Oncology. This review focusses on recent and emerging therapeutic options in metastatic TNBC. ![]() Other areas of therapeutic interest include targeting aberrations in the phosphoinositide 3-kinase pathway, protein kinase B, mammalian target of rapamycin or utilising antibody drug conjugates. There are unanswered questions regarding the role of PARPi maintenance after platinum therapy as is standard of care in BRCA-associated ovarian cancer. There are no head-to-head comparisons of a poly (adenosine diphosphate-ribose) polymerase inhibitors (PARPi) and platinums. The BROCADE3 trial demonstrated that the combination of a platinum and veliparib increased PFS in first-line metastatic TNBC but at the cost of increased toxicity. For those treated with Talazoparib, the time to deterioration in health related-quality of life was also longer compared to chemotherapy. Two phase III trials (OLYMPIAD and BROCADE3) demonstrated a benefit in progression free survival (PFS) but not overall survival in patients with BRCA-associated metastatic TNBC treated with Olaparib or Talazoparib respectively. However, a recent trial in a similar population showed no benefit for atezoli-zumab and paclitaxel which led to a Food and Drug Administration alert. ![]() Recent studies have demonstrated improved progression free survival with the combination of atezolizumab/pembrolizumab and chemotherapy in programmed death-ligand 1 positive metastatic TNBC. Best responses to chemotherapy are predominately in the first line. Metastatic triple negative breast cancer (TNBC) has an aggressive phenotype with a predilection for visceral organs and brain.
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