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Updated: May 27, 2025
Studying Triple Negative Breast Cancer Using Orthotopic Breast Cancer Model
Published on: March 20, 2020
Targeting low-risk triple-negative breast cancer: a review on de-escalation strategies for a new era
1Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
Abstract:
Triple-negative breast cancer (TNBC) is a subtype of breast cancer lacking estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. Comprising 15-20% of breast cancers, TNBC is typically high-grade, affects younger women, and has a poor prognosis. However, TNBC is heterogeneous, encompassing different molecular subtypes and histological types with distinct molecular drivers, prognoses, and treatment responses. Among these, a subset of low-risk diseases associated with a lower risk of recurrence led to the exploration of de-escalation strategies. This review presents the clinicopathological characteristics of special TNBC with a better prognosis that could be spared from aggressive systemic treatment. We searched the PubMed database for articles that could support treatment de-escalation using the keywords "early-stage", "TNBC", and "low-risk". This article addresses four subgroups of low-risk TNBC: special histological types, tumors with high tumor-infiltrating lymphocytes (TILs), low Ki-67 levels, and early-stage tumors that achieved pathological complete response (pCR). The discussion explores the optimization of treatment options ranging from the omission of any systemic treatment to anthracycline-free possibilities and/or immunotherapies. Identifying these tumors can help personalize treatment, reduce costs and unnecessary toxicity, and contribute to a better quality of life for patients with favorable prognoses. Further studies should explore reliable biomarkers to identify these low-risk diseases precisely.
Insights
Certain triple-negative breast cancers (TNBC) have a better prognosis, allowing for less aggressive treatment. Identifying low-risk TNBC subtypes can personalize care and reduce toxicity.
Area of Science:
- Oncology
- Genomics
- Pathology
Background:
- Triple-negative breast cancer (TNBC) lacks ER, PR, and HER2 expression, typically presenting with aggressive features and poor prognosis.
- TNBC is heterogeneous, with distinct molecular subtypes and varying responses to treatment.
- A subset of low-risk TNBC exhibits a reduced recurrence risk, prompting investigation into de-escalation strategies.
Purpose of the Study:
- To review clinicopathological characteristics of prognostically favorable TNBC subtypes amenable to treatment de-escalation.
- To identify specific subgroups of early-stage, low-risk TNBC that may not require aggressive systemic therapy.
- To explore optimized treatment options, including omission of systemic treatment or anthracycline-free/immunotherapy regimens.
Main Methods:
- PubMed database search using keywords: "early-stage", "TNBC", and "low-risk".
- Review of articles supporting treatment de-escalation for specific TNBC subgroups.
- Analysis of clinicopathological features defining low-risk TNBC.
Main Results:
- Identified four subgroups of low-risk TNBC: special histological types, high tumor-infiltrating lymphocytes (TILs), low Ki-67 levels, and tumors achieving pathological complete response (pCR).
- These subgroups present better prognoses, suggesting potential for treatment de-escalation.
- Personalized treatment strategies can reduce costs and toxicity, improving patient quality of life.
Conclusions:
- Accurate identification of low-risk TNBC is crucial for tailoring treatment strategies.
- De-escalation of therapy for specific TNBC subtypes can minimize unnecessary toxicity and improve patient outcomes.
- Further research into reliable biomarkers is needed for precise identification of low-risk TNBC.
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