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Triple-negative breast cancer — Clinical Guidelines

Overview

Triple-negative breast cancer (TNBC) represents approximately 20% of breast cancers globally, characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and HER2 expression, leading to more aggressive behavior and limited targeted treatment options 1.

Diagnosis

Key Criteria: Absence of ER, PR, and HER2 expression 1.

Recommended Tests: Immunohistochemistry (IHC) for ER, PR, and HER2 1.

Genomic Analysis: Consider BRCA1/2 mutation testing, especially in patients with familial history 1.

Management

First-Line Treatments:

- Platinum-based chemotherapy (when applicable) 1. - PARP inhibitors like olaparib for BRCA1-positive patients 1.

Adjunctive Treatments:

- AR inhibition with enzalutamide for advanced disease 2. - Monitor for and manage side effects such as gout-like symptoms with PARP inhibitors 1.

Special Populations

Comorbidities: Consider potential interactions and side effects, such as gout with PARP inhibitor use 1.

Key Recommendations

Consider BRCA1/2 testing in TNBC patients for potential PARP inhibitor therapy (Evidence: Moderate 1).

Evaluate the use of AR inhibitors like enzalutamide in advanced TNBC cases (Evidence: Moderate 2).

Monitor for and manage significant side effects associated with targeted therapies, such as gout with olaparib (Evidence: Expert opinion 1).

References

1 Matthews Hew T, Zuberi L. PARP Inhibitor Olaparib Use in a BRCA1-Positive Patient With Metastatic Triple-Negative Breast Cancer, Without the Initial Use of Platinum-Based Chemotherapy, Showing Significant Rapid Near Resolution of Large Liver Metastasis While Patient Experienced Gout-Like Symptoms. Journal of investigative medicine high impact case reports 2019. link 2 . AR Inhibition Achieves Responses in AR. Cancer discovery 2018. link 3 . Bursts of Chromosome Changes Drive TNBC. Cancer discovery 2016. link 4 LaPorta E, Welsh J. Modeling vitamin D actions in triple negative/basal-like breast cancer. The Journal of steroid biochemistry and molecular biology 2014. link 5 Thompson AM, Newman TJ. Milking the stroma in triple-negative breast cancer. Cell cycle (Georgetown, Tex.) 2012. link

Triple-negative breast cancer