Neoadjuvant Therapy for Patients with Triple Negative Breast Cancer (TNBC)

Background: Patients with triple negative breast cancer (TNBC) are characterized by an unfavorable prognosis particularly when not responding well to anthracycline-taxane chemotherapy. This is due to a more aggressive biology in some cases but most importantly to a lack of agents other than conventional chemotherapy. Hence, there is an urgent need to optimize therapy of patients with TNBC in order to improve prognosis. Objective: The objective of this review is to present the current understanding of TNBC biology and give an insight of current therapeutic concepts in the neoadjuvant treatment setting. Method: Current literature has been selected based on a literature search and current therapeutic concepts are explained and commented on. Results: Novel therapeutic concepts for patients with TNBC focus on a) chemotherapy optimization through alternate scheduling, dosing or alternative/additional chemotherapeutic agents, b) evaluation of novel targeted agents and c) identification of clinically relevant patient subgroups through prognostic/ predictive biomarkers to enable a more personalized treatment approach. Potential novel therapeutic targets include inhibition of Poly-A-Ribose-Polymerase (PARP), checkpoint inhibition and antiandrogenic agents. Conclusion: Treatment of TNBC is currently been optimized both through optimization of chemotherapy and introduction of novel targeted agents which should enhance treatment response rates in the future.