Evolving treatment strategies for triple-negative breast cancer

Although not yet practice changing in early-stage triple-negative breast cancer, growing evidence suggests that neoadjuvant platinum-based therapy is active and that some patients may benefit from such an approach. Recent randomized phase III data suggests that carboplatin has comparable efficacy to docetaxel as first-line therapy in unselected advanced triple-negative breast cancer. In both settings, the efficacy of such treatment appears to be influenced by BRCA1/2 mutation status, with carriers of these mutations experiencing higher response rates. To optimize patient selection, biomarkers of response need to be incorporated into randomized clinical trials and validated. In addition to BRCA1/2, it is likely that measures of genomic instability and other germline biomarkers beyond BRCA1/2 may be associated with therapeutic sensitivity.