![]() Unlike HR+ and HER2+ breast cancer, TNBC is complicated by the (1) scarcity of treatment options outside of cytotoxic chemotherapy more recently immunotherapy in a subset of patients, and (2) limited predictive and prognostic biomarkers to tailor treatment. ![]() 2 Treatment personalization guided by clinical and genomic tumor characteristics has become standard of care in patients with early-stage hormone-receptor positive (HR+) and HER2-neu amplified (HER2+) breast cancer, thus successfully de-escalating and escalating therapy in appropriate patients. 1 TNBC is associated with poor long-term outcomes compared with other breast cancers. Triple-negative breast cancer (TNBC), which is defined by the lack of expression of estrogen receptor (ER) and progesterone receptor (PR) and absence of HER2 overexpression and/or gene amplification accounts for 15%-20% of all breast cancers diagnosed worldwide each year. Here, we provide an update on the current evidence to support future studies examining de-escalating chemotherapy in patients with low-risk TNBC and adjuvant intensification strategies to improve outcomes for patients who are at high risk for systemic failure despite current standard-of-care treatments. Recent developments in understanding TNBC biology have sparked interest in exploring treatment optimization and personalization with the goal of achieving excellent response rates and long-term clinical outcomes, while simultaneously reducing physical, psychological, and financial toxicities for select patients. Personalizing therapy in TNBC represents a challenge due to the scarcity of treatment options outside of cytotoxic chemotherapy and limited predictive and prognostic biomarkers to tailor treatment. At present, robust strategies to personalize therapy in early-stage TNBC do not exist, and despite excellent response rates in a subset of patients, all patients are exposed to the same several cycles of cytotoxic chemotherapy. Attempts to de-escalate chemotherapy in hormone-receptor-positive (HR+) and HER2-neu amplified breast cancer subtypes have been successful. Although historically TNBC is considered difficult to treat with a poor prognosis, there is emerging evidence showing excellent response rates in a subset of TNBC patients. Triple-negative breast cancer (TNBC) accounts for approximately 15%-20% of breast cancers diagnosed worldwide, which amounts to almost 200 000 cases each year.
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