Treatment of Triple-negative Breast Cancer

Triple-negative breast cancer (TNBC) doesn’t have estrogen or progesterone receptors and also doesn’t make too much of the HER2 protein. Because the cancer cells lack these proteins, hormone therapy and drugs that target HER2 are not helpful, so chemotherapy (chemo) is the main systemic treatment option. And although TNBC tends to respond well to initial chemo, it tends to come back (recur) more frequently than other breast cancers.

Stages I-III triple-negative breast cancer

If the early-stage TNBC tumor is small enough to be removed by surgery, then breast-conserving surgery or a mastectomy with a check of the lymph nodes may be done. In certain cases, such as with a large tumor or if the lymph nodes are found to have cancer, radiation may follow surgery.

Because hormone therapy and HER2 drugs are not good options for women with TNBC, chemotherapy is the main systemic option. It might be given before surgery (neoadjuvant chemotherapy) by itself or with pembrolizumab to shrink a large tumor. You might also be given chemo or pembrolizumab after surgery (adjuvant treatment) to reduce the chances of the cancer coming back.  

Stage IV triple-negative breast cancer

Chemo is often used first when the cancer has spread to other parts of the body (stage IV). Common chemo drugs used include anthracyclines, taxanes, capecitabine, gemcitabine, eribulin, and others. 

For women with TNBC who have a BRCA mutation and whose cancer no longer responds to common breast cancer chemo drugs, other chemo drugs called platinum drugs (like cisplatin or carboplatin) or targeted drugs called PARP inhibitors, such as olaparib (Lynparza) or talazoparib (Talzenna), may be considered.

For advanced TNBC in which the cancer cells have the PD-L1 protein, the first treatment may be immunotherapy plus chemo (either atezolizumab along with albumin-bound paclitaxel, or pembrolizumab and chemotherapy). The PD-L1 protein is found in about 1 out of 5 TNBCs.

For advanced TNBC in which at least 2 other drug treatments have already been tried, the antibody-drug conjugate sacituzumab govitecan (Trodelvy) might be an option.

Surgery and radiation may also be options in certain situations. 

See Treatment of Stage IV (Advanced) Breast Cancer for more information.

Recurrent triple-negative breast cancer

If TNBC comes back (recurs) locally, cannot be removed with surgery, and makes the PD-L1 protein, immunotherapy with the drug pembrolizumab along with chemotherapy is an option. Other treatments might be options as well, depending on the situation.

If the cancer recurs in other parts of the body, options might include chemotherapy or the antibody-drug conjugate sacituzumab govitecan (Trodelvy).

Regardless of the stage of the cancer, participation in a clinical trial of new treatments for TNBC is also a good option because TNBC is uncommon and tends to have a poor prognosis (outcome) compared to other types of breast cancer, and because these studies often allow patients to have access to drugs not available for standard treatment.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Anders CK and Carey LA. ER/PR negative, HER2-negative (triple-negative) breast cancer. UpToDate website. https://www.uptodate.com/contents/er-pr-negative-her2-negative-triple-negative-breast-cancer. Updated June 06, 2019. Accessed July 23, 2019. 

Bardia A, Mayer IA, Diamond JR, et al. Efficacy and Safety of Anti-Trop-2 Antibody Drug Conjugate Sacituzumab Govitecan (IMMU-132) in Heavily Pretreated Patients With Metastatic Triple-Negative Breast Cancer. J Clin Oncol. 2017;35(19):2141‐2148. doi:10.1200/JCO.2016.70.8297.

Jhan JR, Andrechek ER. Triple-negative breast cancer and the potential for targeted therapy. Pharmacogenomics. 2017;18(17):1595–1609.

Li X, Yang J, Peng L, Sahin AA, Huo L, Ward KC, O'Regan R, Torres MA, Meisel JL. Triple-negative breast cancer has worse overall survival and cause-specific survival than non-triple-negative breast cancer. Breast Cancer Res Treat. 2017 Jan;161(2):279-287.

Morrow M, Burstein HJ, Harris JR. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

National Cancer Institute. Physician Data Query (PDQ). Breast Cancer Treatment – Health Professional Version. 2019. Accessed at https://www.cancer.gov/types/breast/hp/breast-treatment-pdq on August 9, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 2.2017. Accessed at www.nccn.org on July 20, 20167

Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Chapter 91: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.

References

Anders CK and Carey LA. ER/PR negative, HER2-negative (triple-negative) breast cancer. UpToDate website. https://www.uptodate.com/contents/er-pr-negative-her2-negative-triple-negative-breast-cancer. Updated June 06, 2019. Accessed July 23, 2019. 

Bardia A, Mayer IA, Diamond JR, et al. Efficacy and Safety of Anti-Trop-2 Antibody Drug Conjugate Sacituzumab Govitecan (IMMU-132) in Heavily Pretreated Patients With Metastatic Triple-Negative Breast Cancer. J Clin Oncol. 2017;35(19):2141‐2148. doi:10.1200/JCO.2016.70.8297.

Jhan JR, Andrechek ER. Triple-negative breast cancer and the potential for targeted therapy. Pharmacogenomics. 2017;18(17):1595–1609.

Li X, Yang J, Peng L, Sahin AA, Huo L, Ward KC, O'Regan R, Torres MA, Meisel JL. Triple-negative breast cancer has worse overall survival and cause-specific survival than non-triple-negative breast cancer. Breast Cancer Res Treat. 2017 Jan;161(2):279-287.

Morrow M, Burstein HJ, Harris JR. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

National Cancer Institute. Physician Data Query (PDQ). Breast Cancer Treatment – Health Professional Version. 2019. Accessed at https://www.cancer.gov/types/breast/hp/breast-treatment-pdq on August 9, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 2.2017. Accessed at www.nccn.org on July 20, 20167

Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Chapter 91: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.

Last Revised: July 27, 2021

 

 

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.