Treatment for Metastatic Triple-Negative Breast Cancer

First-Line Treatment Options

The American Society of Clinical Oncology recommends immune checkpoint inhibitor plus chemotherapy as first-line therapy for patients with PD-L1-positive metastatic TNBC, which has demonstrated improved progression-free survival compared to chemotherapy alone 1, 2, 3
For patients with PD-L1-negative disease, single-agent chemotherapy is preferred for first-line treatment, with combination chemotherapy considered for patients with symptomatic or immediately life-threatening disease 1, 2, 3
Taxanes, such as paclitaxel or docetaxel, are preferred first-line chemotherapy options if not previously used in the adjuvant setting, according to the National Comprehensive Cancer Network 1, 4
Anthracyclines, such as doxorubicin or epirubicin, are recommended if not previously used, as stated by the National Comprehensive Cancer Network 5, 6
Platinum agents, such as carboplatin or cisplatin, with or without taxanes, are also appropriate options, with selection based on individual risk-benefit assessment, as recommended by the National Comprehensive Cancer Network 5, 6

For patients with germline BRCA1/2 mutations, PARP inhibitors, such as olaparib or talazoparib, are recommended rather than chemotherapy, as stated by the American Society of Clinical Oncology 2, 3, 7
Sacituzumab govitecan is strongly recommended for patients who have received at least two prior therapies for metastatic disease, with significant improvement in both progression-free survival and overall survival, as demonstrated in the ASCENT trial 1, 2
The National Comprehensive Cancer Network recommends considering anthracyclines and vice versa if previously treated with taxanes, as well as additional options such as capecitabine/docetaxel, gemcitabine/paclitaxel, and eribulin 4, 5, 6

Sequential single-agent chemotherapy is generally preferred over combination regimens to minimize toxicity, except in cases of visceral crisis or rapidly progressing disease, as recommended by the American Society of Clinical Oncology 1, 4
Combination regimens may offer higher response rates but often with increased toxicity, as stated by the National Comprehensive Cancer Network 5, 6
Platinum agents have shown particular efficacy in TNBC, with potential small survival benefits, but with increased toxicity, including nausea, vomiting, and anemia, as reported by the American Society of Clinical Oncology 8
Bevacizumab combined with chemotherapy has shown improved progression-free survival but not overall survival in some studies, as stated by the National Comprehensive Cancer Network 5, 6

Patients should be monitored closely for immune-related adverse events when receiving checkpoint inhibitors, as recommended by the American Society of Clinical Oncology 1, 2

Combination chemotherapy should only be used for symptomatic visceral crisis requiring rapid response, immediately life-threatening disease, or rapidly progressive disease with risk of patient deterioration, as recommended by the European Society for Medical Oncology 9
Triple-negative biology alone does not mandate combination chemotherapy, according to the European Society for Medical Oncology 10, 9

Taxane-based regimens are the only standard of care with level 1 evidence for first-line therapy in patients progressing after adjuvant anthracycline-based chemotherapy, as stated by the European Society for Medical Oncology 10, 9
Platinum agents demonstrate particular efficacy in TNBC with potential small survival benefits, but increased toxicity includes nausea, vomiting, and anemia, as reported by the American Society of Clinical Oncology 11
The TNT trial showed similar overall response rates between carboplatin (31.4%) and docetaxel (34.0%) in first-line metastatic TNBC, according to the American Society of Clinical Oncology 11

After ≥2 prior therapies, sacituzumab govitecan is strongly recommended with significant improvements in both progression-free survival and overall survival, as recommended by the American Society of Clinical Oncology 11