Neoadjuvant treatments in triple-negative breast cancer patients: where we are now and where we are going

Abstract: Triple-negative breast cancer (TNBC) remains the poorest-prognosis breast cancer(BC) subtype. Gene expression profiling has identified at least six different triple-negativesubtypes with different biology and sensitivity to therapies. The heterogeneous nature of TNtumors may justify the difficulty in treating this BC subtype. Several targeted agents have beeninvestigated in clinical trials without demonstrating a clear survival benefit. Therefore, systemicchemotherapy remains the cornerstone of current clinical practice. Improving the knowledge oftumor biology is mandatory for patient management. In stages II and III, neoadjuvant systemictreatment is an effective option of care. The achievement of a pathological complete responserepresents an optimal surrogate for survival outcome as well as a test for tumor drug sensitivity.In this review, we provide a brief description of the main predictive biomarkers for tumorresponse to systemic treatment. Moreover, we review the treatment strategies investigated forTNBCs in neoadjuvant settings focusing on experimental drugs such as immunotherapy andpoly [ADP-ribose] polymerase inhibitors that hold promise in the treatment of this aggressivedisease. Therefore, the management of TNBC represents an urgent, current, unmet need in dailyclinical practice. A key recommendation is to design biology-driven clinical trials wherein TNBCpatients may be treated on the basis of tumor molecular profile.