Triple Negative Breast Cancer: Pitfalls and Progress

Breast cancer remains to be the most common and the main cause cancer related mortality worldwide. In a recent population based epidemiological study, it was found that BC is more commonly found in Black and young women. TNBC i.e., Tripple Negative Breast Cancer is a type of breast cancer that lacks expression of estrogen and progesterone receptors and also lacks overexpression of Human Epidermal Growth Factor Receptor -2 (HER2). It usually presents as invasive ductal carcinoma and is very aggressive in nature. Owing to its inherent aggressive nature and limited therapeutic options, the prognosis is usually very poor. Advances in treatment of this cancer have been made in terms of therapy intensification, poly chemotherapy, immunotherapy; as compared to the past treatment. Recent treatment options include approval of novel chemotherapeutic agents i.e., PARPi (poly adenosine ribose polymerase inhibitor), which is the first immunotherapy regimen for treatment of early disease as well as metastatic disease, specifically for the treatment of patients with germline BRAC1/2 mutation. However, there is still lack of the of a tumor targeted therapy which is the biggest limitation faced in treatment if this breast cancer . Apart from this, due to the intrinsic aggressive nature, the chances of recurrence remain extremely high specifically within five years of diagnoses. As discussed earlier, the risk of recurrence has reduced over the time due to advances in the chemotherapeutic regimen like addition of immune checkpoint inhibitors to standard systemic chemotherapeutic regimen, which has improved outcomes in TNBC patients. Antibody drug conjugates seem to have a promising future specifically as a targeted chemotherapy and hence reducing toxicities.