Triple-negative breast cancer: unique biology and its management

Triple-negative breast cancer is defined by the lack of expression of estrogen-receptor, progesterone-receptor, and HER-2/neu. It primarily, but not exclusively, carries the basal-like molecular profile on gene expression arrays and is associated with BRCA-1 and p53 mutations. It has an aggressive behavior and predilection for visceral metastasis, therefore accounting for its poor prognosis. Despite lacking targeted therapies, it is sensitive to anthracyclines and taxanes. Increasing knowledge has generated a better understanding of its pathophysiology, therefore leading to the development of directed therapies, although their validation still needs further investigation. This review focuses on its biology, management, evolving concepts, and future directions.