ESMO E-Learning: Triple Negative Breast Cancer

This E-learning module is a completely new one replacing the previous ESMO module on triple negative breast cancer (TNBC). The authors illustrate findings from clinical trials in advanced and early disease and contextualise a great deal of novelties from clinical trials with immune checkpoint and PARP inhibitors in these settings, as well as opening the opportunity for a new treatment option for the large subset of patients with HER2-low disease.

The authors, by describing key TNBC characteristics, go in depth into testing guidelines for hormone receptors and elaborate cut-off for oestrogen receptor negative breast tumours. They also describe routine evaluation of tumour infiltrating lymphocytes in TNBC.

The chapter on advanced disease, starts with the description of clinical features of metastatic TNBC, explaining the rationale for immunotherapy in TNBC and chemotherapy as a trigger for immune activation, followed by key results from recent randomised clinical trials. The authors perform a head-to-head comparison of the key results and explain the reasons for discrepant results between the trials; they also explain the sources of variability in terms of PD-L1 assessment. The part on metastatic setting is devoted to key findings from the clinical trials with PARP inhibitors and is followed by findings from the study with humanised anti-TROP2 antibody, sacituzumab govitecan in pretreated TNBC. The authors feature the findings from the first randomised clinical trial to show that targeting HER2 provides benefit in patients with HER2-low metastatic breast cancer. The authors also elaborate brain metastases from TNBC.  ​

The part of the module devoted to early TNBC starts by describing a progress in adjuvant chemotherapy and the optimisation of the standard therapy in terms of timing, schedule, and dose density. The authors explain TNBC from the neoadjuvant approach, as a concept very suitable for treatment personalisation, and illustrate it with findings from clinical trials. This is followed by the elaboration of key findings from clinical trials that aimed to improve beyond the standard therapy by adding neoadjuvant platinum salts, immunotherapy research, as well as adjuvant olaparib in patients with high-risk BRCA-mutated TNBC.